|
Osmolality, Serum
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
852898
|
|
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, Urine
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1281255
|
|
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
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1281255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| 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: AHCCCS Medicaid |
$6.82
|
| Rate for Payer: Allwell Medicaid |
$6.82
|
| Rate for Payer: Allwell Medicare |
$22.20
|
| Rate for Payer: Amerigroup Medicare |
$22.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicaid |
$6.82
|
| Rate for Payer: AZCH Complete Medicare |
$22.20
|
| Rate for Payer: Banner UC Health Medicaid |
$6.82
|
| Rate for Payer: Banner UC Health Medicare |
$22.20
|
| 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: 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 |
$22.20
|
| Rate for Payer: Mercy Care Medicaid |
$6.82
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$22.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
|
Osmolality, Urine LC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
1905826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| 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: AHCCCS Medicaid |
$6.82
|
| Rate for Payer: Allwell Medicaid |
$6.82
|
| Rate for Payer: Allwell Medicare |
$22.20
|
| Rate for Payer: Amerigroup Medicare |
$22.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$55.28
|
| Rate for Payer: AZCH Complete Medicaid |
$6.82
|
| Rate for Payer: AZCH Complete Medicare |
$22.20
|
| Rate for Payer: Banner UC Health Medicaid |
$6.82
|
| Rate for Payer: Banner UC Health Medicare |
$22.20
|
| 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: 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 |
$22.20
|
| Rate for Payer: Mercy Care Medicaid |
$6.82
|
| Rate for Payer: Self Pay Self Pay |
$118.40
|
| Rate for Payer: TriWest Medicare |
$22.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$86.28
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$26.64
|
|
|
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
|
|
|
OSTECTOMY CALCANEUS;
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
24043315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$1,824.30 |
| Rate for Payer: Aetna of AZ Commercial |
$1,824.30
|
| Rate for Payer: Bisbee Police All Plans |
$527.02
|
| Rate for Payer: Cash Price |
$1,621.60
|
| Rate for Payer: Self Pay Self Pay |
$1,621.60
|
|
|
OSTECTOMY CALCANEUS;
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
24043315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,824.30
|
| Rate for Payer: Aetna of AZ Medicare |
$567.56
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$304.05
|
| Rate for Payer: Amerigroup Medicare |
$304.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$757.08
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$304.05
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$304.05
|
| Rate for Payer: Bisbee Police All Plans |
$527.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,378.36
|
| Rate for Payer: Cash Price |
$1,621.60
|
| Rate for Payer: Cash Price |
$1,621.60
|
| Rate for Payer: Cigna of AZ Commercial |
$1,013.50
|
| Rate for Payer: Copperpoint Commercial |
$501.68
|
| Rate for Payer: Health Net of AZ Commercial |
$1,216.20
|
| Rate for Payer: Health Net of AZ Medicare |
$567.56
|
| Rate for Payer: Humana of AZ Medicare |
$304.05
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,621.60
|
| Rate for Payer: TriWest Medicare |
$304.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$364.86
|
|
|
OSTECTOMY COMPLETE EXCISION; FIFTH METATARSAL HEAD - Tech
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
24043314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,863.00
|
| Rate for Payer: Bisbee Police All Plans |
$538.20
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Self Pay Self Pay |
$1,656.00
|
|
|
OSTECTOMY COMPLETE EXCISION; FIFTH METATARSAL HEAD - Tech
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
24043314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$310.50 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,863.00
|
| Rate for Payer: Aetna of AZ Medicare |
$579.60
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$310.50
|
| Rate for Payer: Amerigroup Medicare |
$310.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$773.14
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$310.50
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$310.50
|
| Rate for Payer: Bisbee Police All Plans |
$538.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,407.60
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,035.00
|
| Rate for Payer: Copperpoint Commercial |
$512.32
|
| Rate for Payer: Health Net of AZ Commercial |
$1,242.00
|
| Rate for Payer: Health Net of AZ Medicare |
$579.60
|
| Rate for Payer: Humana of AZ Medicare |
$310.50
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,656.00
|
| Rate for Payer: TriWest Medicare |
$310.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$372.60
|
|
|
OSTECTOMY COMPLETE EXCISION; FIRST METATARSAL HEAD - Tech
|
Facility
|
OP
|
$1,583.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
24043313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.45 |
| Max. Negotiated Rate |
$4,104.08 |
| Rate for Payer: Aetna of AZ Commercial |
$1,424.70
|
| Rate for Payer: Aetna of AZ Medicare |
$443.24
|
| Rate for Payer: AHCCCS Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicaid |
$4,104.08
|
| Rate for Payer: Allwell Medicare |
$237.45
|
| Rate for Payer: Amerigroup Medicare |
$237.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$591.25
|
| Rate for Payer: AZCH Complete Medicaid |
$4,104.08
|
| Rate for Payer: AZCH Complete Medicare |
$237.45
|
| Rate for Payer: Banner UC Health Medicaid |
$4,104.08
|
| Rate for Payer: Banner UC Health Medicare |
$237.45
|
| Rate for Payer: Bisbee Police All Plans |
$411.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,076.44
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cigna of AZ Commercial |
$791.50
|
| Rate for Payer: Copperpoint Commercial |
$391.79
|
| Rate for Payer: Health Net of AZ Commercial |
$949.80
|
| Rate for Payer: Health Net of AZ Medicare |
$443.24
|
| Rate for Payer: Humana of AZ Medicare |
$237.45
|
| Rate for Payer: Mercy Care Medicaid |
$4,104.08
|
| Rate for Payer: Self Pay Self Pay |
$1,266.40
|
| Rate for Payer: TriWest Medicare |
$237.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$284.94
|
|
|
OSTECTOMY COMPLETE EXCISION; FIRST METATARSAL HEAD - Tech
|
Facility
|
IP
|
$1,583.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
24043313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$411.58 |
| Max. Negotiated Rate |
$1,424.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,424.70
|
| Rate for Payer: Bisbee Police All Plans |
$411.58
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Self Pay Self Pay |
$1,266.40
|
|
|
Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections
|
Facility
|
IP
|
$9,085.23
|
|
|
Service Code
|
APR-DRG 3443
|
| Hospital Charge Code |
APRDRG3442
|
| 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 |
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
|
$6,142.86
|
|
|
Service Code
|
APR-DRG 3442
|
| Hospital Charge Code |
APRDRG3441
|
| 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
|
$9,085.23
|
|
|
Service Code
|
APR-DRG 3443
|
| Hospital Charge Code |
APRDRG3441
|
| 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
|
$15,890.22
|
|
|
Service Code
|
APR-DRG 3444
|
| Hospital Charge Code |
APRDRG3442
|
| 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
|
$15,890.22
|
|
|
Service Code
|
APR-DRG 3444
|
| Hospital Charge Code |
APRDRG3441
|
| 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 |
APRDRG3442
|
| 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 |
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
|
|
|
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
|
$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 |
APRDRG3443
|
| 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
|
$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
|
|
