|
Other Chemotherapy
|
Facility
|
IP
|
$25,898.49
|
|
|
Service Code
|
APR-DRG 6964
|
| Hospital Charge Code |
APRDRG6961
|
| Min. Negotiated Rate |
$25,898.49 |
| Max. Negotiated Rate |
$25,898.49 |
| Rate for Payer: AHCCCS Medicaid |
$25,898.49
|
| Rate for Payer: Allwell Medicaid |
$25,898.49
|
| Rate for Payer: AZCH Complete Medicaid |
$25,898.49
|
| Rate for Payer: Banner UC Health Medicaid |
$25,898.49
|
| Rate for Payer: Mercy Care Medicaid |
$25,898.49
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$5,112.50
|
|
|
Service Code
|
APR-DRG 6961
|
| Hospital Charge Code |
APRDRG6964
|
| Min. Negotiated Rate |
$5,112.50 |
| Max. Negotiated Rate |
$5,112.50 |
| Rate for Payer: AHCCCS Medicaid |
$5,112.50
|
| Rate for Payer: Allwell Medicaid |
$5,112.50
|
| Rate for Payer: AZCH Complete Medicaid |
$5,112.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5,112.50
|
| Rate for Payer: Mercy Care Medicaid |
$5,112.50
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$11,081.42
|
|
|
Service Code
|
APR-DRG 6963
|
| Hospital Charge Code |
APRDRG6963
|
| Min. Negotiated Rate |
$11,081.42 |
| Max. Negotiated Rate |
$11,081.42 |
| Rate for Payer: AHCCCS Medicaid |
$11,081.42
|
| Rate for Payer: Allwell Medicaid |
$11,081.42
|
| Rate for Payer: AZCH Complete Medicaid |
$11,081.42
|
| Rate for Payer: Banner UC Health Medicaid |
$11,081.42
|
| Rate for Payer: Mercy Care Medicaid |
$11,081.42
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$6,492.16
|
|
|
Service Code
|
APR-DRG 6962
|
| Hospital Charge Code |
APRDRG6962
|
| Min. Negotiated Rate |
$6,492.16 |
| Max. Negotiated Rate |
$6,492.16 |
| Rate for Payer: AHCCCS Medicaid |
$6,492.16
|
| Rate for Payer: Allwell Medicaid |
$6,492.16
|
| Rate for Payer: AZCH Complete Medicaid |
$6,492.16
|
| Rate for Payer: Banner UC Health Medicaid |
$6,492.16
|
| Rate for Payer: Mercy Care Medicaid |
$6,492.16
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$25,898.49
|
|
|
Service Code
|
APR-DRG 6964
|
| Hospital Charge Code |
APRDRG6962
|
| Min. Negotiated Rate |
$25,898.49 |
| Max. Negotiated Rate |
$25,898.49 |
| Rate for Payer: AHCCCS Medicaid |
$25,898.49
|
| Rate for Payer: Allwell Medicaid |
$25,898.49
|
| Rate for Payer: AZCH Complete Medicaid |
$25,898.49
|
| Rate for Payer: Banner UC Health Medicaid |
$25,898.49
|
| Rate for Payer: Mercy Care Medicaid |
$25,898.49
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$25,898.49
|
|
|
Service Code
|
APR-DRG 6964
|
| Hospital Charge Code |
APRDRG6963
|
| Min. Negotiated Rate |
$25,898.49 |
| Max. Negotiated Rate |
$25,898.49 |
| Rate for Payer: AHCCCS Medicaid |
$25,898.49
|
| Rate for Payer: Allwell Medicaid |
$25,898.49
|
| Rate for Payer: AZCH Complete Medicaid |
$25,898.49
|
| Rate for Payer: Banner UC Health Medicaid |
$25,898.49
|
| Rate for Payer: Mercy Care Medicaid |
$25,898.49
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$5,112.50
|
|
|
Service Code
|
APR-DRG 6961
|
| Hospital Charge Code |
APRDRG6961
|
| Min. Negotiated Rate |
$5,112.50 |
| Max. Negotiated Rate |
$5,112.50 |
| Rate for Payer: AHCCCS Medicaid |
$5,112.50
|
| Rate for Payer: Allwell Medicaid |
$5,112.50
|
| Rate for Payer: AZCH Complete Medicaid |
$5,112.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5,112.50
|
| Rate for Payer: Mercy Care Medicaid |
$5,112.50
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$6,492.16
|
|
|
Service Code
|
APR-DRG 6962
|
| Hospital Charge Code |
APRDRG6964
|
| Min. Negotiated Rate |
$6,492.16 |
| Max. Negotiated Rate |
$6,492.16 |
| Rate for Payer: AHCCCS Medicaid |
$6,492.16
|
| Rate for Payer: Allwell Medicaid |
$6,492.16
|
| Rate for Payer: AZCH Complete Medicaid |
$6,492.16
|
| Rate for Payer: Banner UC Health Medicaid |
$6,492.16
|
| Rate for Payer: Mercy Care Medicaid |
$6,492.16
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$25,898.49
|
|
|
Service Code
|
APR-DRG 6964
|
| Hospital Charge Code |
APRDRG6964
|
| Min. Negotiated Rate |
$25,898.49 |
| Max. Negotiated Rate |
$25,898.49 |
| Rate for Payer: AHCCCS Medicaid |
$25,898.49
|
| Rate for Payer: Allwell Medicaid |
$25,898.49
|
| Rate for Payer: AZCH Complete Medicaid |
$25,898.49
|
| Rate for Payer: Banner UC Health Medicaid |
$25,898.49
|
| Rate for Payer: Mercy Care Medicaid |
$25,898.49
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$5,112.50
|
|
|
Service Code
|
APR-DRG 6961
|
| Hospital Charge Code |
APRDRG6963
|
| Min. Negotiated Rate |
$5,112.50 |
| Max. Negotiated Rate |
$5,112.50 |
| Rate for Payer: AHCCCS Medicaid |
$5,112.50
|
| Rate for Payer: Allwell Medicaid |
$5,112.50
|
| Rate for Payer: AZCH Complete Medicaid |
$5,112.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5,112.50
|
| Rate for Payer: Mercy Care Medicaid |
$5,112.50
|
|
|
Other Chemotherapy
|
Facility
|
IP
|
$5,112.50
|
|
|
Service Code
|
APR-DRG 6961
|
| Hospital Charge Code |
APRDRG6962
|
| Min. Negotiated Rate |
$5,112.50 |
| Max. Negotiated Rate |
$5,112.50 |
| Rate for Payer: AHCCCS Medicaid |
$5,112.50
|
| Rate for Payer: Allwell Medicaid |
$5,112.50
|
| Rate for Payer: AZCH Complete Medicaid |
$5,112.50
|
| Rate for Payer: Banner UC Health Medicaid |
$5,112.50
|
| Rate for Payer: Mercy Care Medicaid |
$5,112.50
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$11,589.93
|
|
|
Service Code
|
APR-DRG 2074
|
| Hospital Charge Code |
APRDRG2074
|
| Min. Negotiated Rate |
$11,589.93 |
| Max. Negotiated Rate |
$11,589.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,589.93
|
| Rate for Payer: Allwell Medicaid |
$11,589.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,589.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,589.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,589.93
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$6,596.67
|
|
|
Service Code
|
APR-DRG 2073
|
| Hospital Charge Code |
APRDRG2071
|
| Min. Negotiated Rate |
$6,596.67 |
| Max. Negotiated Rate |
$6,596.67 |
| Rate for Payer: AHCCCS Medicaid |
$6,596.67
|
| Rate for Payer: Allwell Medicaid |
$6,596.67
|
| Rate for Payer: AZCH Complete Medicaid |
$6,596.67
|
| Rate for Payer: Banner UC Health Medicaid |
$6,596.67
|
| Rate for Payer: Mercy Care Medicaid |
$6,596.67
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$6,596.67
|
|
|
Service Code
|
APR-DRG 2073
|
| Hospital Charge Code |
APRDRG2073
|
| Min. Negotiated Rate |
$6,596.67 |
| Max. Negotiated Rate |
$6,596.67 |
| Rate for Payer: AHCCCS Medicaid |
$6,596.67
|
| Rate for Payer: Allwell Medicaid |
$6,596.67
|
| Rate for Payer: AZCH Complete Medicaid |
$6,596.67
|
| Rate for Payer: Banner UC Health Medicaid |
$6,596.67
|
| Rate for Payer: Mercy Care Medicaid |
$6,596.67
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$3,586.26
|
|
|
Service Code
|
APR-DRG 2071
|
| Hospital Charge Code |
APRDRG2074
|
| Min. Negotiated Rate |
$3,586.26 |
| Max. Negotiated Rate |
$3,586.26 |
| Rate for Payer: AHCCCS Medicaid |
$3,586.26
|
| Rate for Payer: Allwell Medicaid |
$3,586.26
|
| Rate for Payer: AZCH Complete Medicaid |
$3,586.26
|
| Rate for Payer: Banner UC Health Medicaid |
$3,586.26
|
| Rate for Payer: Mercy Care Medicaid |
$3,586.26
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 2072
|
| Hospital Charge Code |
APRDRG2072
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$6,596.67
|
|
|
Service Code
|
APR-DRG 2073
|
| Hospital Charge Code |
APRDRG2074
|
| Min. Negotiated Rate |
$6,596.67 |
| Max. Negotiated Rate |
$6,596.67 |
| Rate for Payer: AHCCCS Medicaid |
$6,596.67
|
| Rate for Payer: Allwell Medicaid |
$6,596.67
|
| Rate for Payer: AZCH Complete Medicaid |
$6,596.67
|
| Rate for Payer: Banner UC Health Medicaid |
$6,596.67
|
| Rate for Payer: Mercy Care Medicaid |
$6,596.67
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$6,596.67
|
|
|
Service Code
|
APR-DRG 2073
|
| Hospital Charge Code |
APRDRG2072
|
| Min. Negotiated Rate |
$6,596.67 |
| Max. Negotiated Rate |
$6,596.67 |
| Rate for Payer: AHCCCS Medicaid |
$6,596.67
|
| Rate for Payer: Allwell Medicaid |
$6,596.67
|
| Rate for Payer: AZCH Complete Medicaid |
$6,596.67
|
| Rate for Payer: Banner UC Health Medicaid |
$6,596.67
|
| Rate for Payer: Mercy Care Medicaid |
$6,596.67
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 2072
|
| Hospital Charge Code |
APRDRG2074
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$3,586.26
|
|
|
Service Code
|
APR-DRG 2071
|
| Hospital Charge Code |
APRDRG2071
|
| Min. Negotiated Rate |
$3,586.26 |
| Max. Negotiated Rate |
$3,586.26 |
| Rate for Payer: AHCCCS Medicaid |
$3,586.26
|
| Rate for Payer: Allwell Medicaid |
$3,586.26
|
| Rate for Payer: AZCH Complete Medicaid |
$3,586.26
|
| Rate for Payer: Banner UC Health Medicaid |
$3,586.26
|
| Rate for Payer: Mercy Care Medicaid |
$3,586.26
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 2072
|
| Hospital Charge Code |
APRDRG2073
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$11,589.93
|
|
|
Service Code
|
APR-DRG 2074
|
| Hospital Charge Code |
APRDRG2071
|
| Min. Negotiated Rate |
$11,589.93 |
| Max. Negotiated Rate |
$11,589.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,589.93
|
| Rate for Payer: Allwell Medicaid |
$11,589.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,589.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,589.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,589.93
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$3,586.26
|
|
|
Service Code
|
APR-DRG 2071
|
| Hospital Charge Code |
APRDRG2073
|
| Min. Negotiated Rate |
$3,586.26 |
| Max. Negotiated Rate |
$3,586.26 |
| Rate for Payer: AHCCCS Medicaid |
$3,586.26
|
| Rate for Payer: Allwell Medicaid |
$3,586.26
|
| Rate for Payer: AZCH Complete Medicaid |
$3,586.26
|
| Rate for Payer: Banner UC Health Medicaid |
$3,586.26
|
| Rate for Payer: Mercy Care Medicaid |
$3,586.26
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$11,589.93
|
|
|
Service Code
|
APR-DRG 2074
|
| Hospital Charge Code |
APRDRG2073
|
| Min. Negotiated Rate |
$11,589.93 |
| Max. Negotiated Rate |
$11,589.93 |
| Rate for Payer: AHCCCS Medicaid |
$11,589.93
|
| Rate for Payer: Allwell Medicaid |
$11,589.93
|
| Rate for Payer: AZCH Complete Medicaid |
$11,589.93
|
| Rate for Payer: Banner UC Health Medicaid |
$11,589.93
|
| Rate for Payer: Mercy Care Medicaid |
$11,589.93
|
|
|
Other Circulatory System Diagnoses
|
Facility
|
IP
|
$4,564.01
|
|
|
Service Code
|
APR-DRG 2072
|
| Hospital Charge Code |
APRDRG2071
|
| Min. Negotiated Rate |
$4,564.01 |
| Max. Negotiated Rate |
$4,564.01 |
| Rate for Payer: AHCCCS Medicaid |
$4,564.01
|
| Rate for Payer: Allwell Medicaid |
$4,564.01
|
| Rate for Payer: AZCH Complete Medicaid |
$4,564.01
|
| Rate for Payer: Banner UC Health Medicaid |
$4,564.01
|
| Rate for Payer: Mercy Care Medicaid |
$4,564.01
|
|
