|
ABORh
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
1481849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna of AZ Commercial |
$80.10
|
| Rate for Payer: Bisbee Police All Plans |
$23.14
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Self Pay Self Pay |
$71.20
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$3,385.66
|
|
|
Service Code
|
APR-DRG 5431
|
| Hospital Charge Code |
APRDRG5433
|
| Min. Negotiated Rate |
$3,385.66 |
| Max. Negotiated Rate |
$3,385.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,385.66
|
| Rate for Payer: Allwell Medicaid |
$3,385.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,385.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,385.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,385.66
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$3,385.66
|
|
|
Service Code
|
APR-DRG 5431
|
| Hospital Charge Code |
APRDRG5434
|
| Min. Negotiated Rate |
$3,385.66 |
| Max. Negotiated Rate |
$3,385.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,385.66
|
| Rate for Payer: Allwell Medicaid |
$3,385.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,385.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,385.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,385.66
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$3,385.66
|
|
|
Service Code
|
APR-DRG 5431
|
| Hospital Charge Code |
APRDRG5431
|
| Min. Negotiated Rate |
$3,385.66 |
| Max. Negotiated Rate |
$3,385.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,385.66
|
| Rate for Payer: Allwell Medicaid |
$3,385.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,385.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,385.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,385.66
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,146.68
|
|
|
Service Code
|
APR-DRG 5432
|
| Hospital Charge Code |
APRDRG5433
|
| Min. Negotiated Rate |
$4,146.68 |
| Max. Negotiated Rate |
$4,146.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,146.68
|
| Rate for Payer: Allwell Medicaid |
$4,146.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,146.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,146.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,146.68
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$13,229.11
|
|
|
Service Code
|
APR-DRG 5434
|
| Hospital Charge Code |
APRDRG5434
|
| Min. Negotiated Rate |
$13,229.11 |
| Max. Negotiated Rate |
$13,229.11 |
| Rate for Payer: AHCCCS Medicaid |
$13,229.11
|
| Rate for Payer: Allwell Medicaid |
$13,229.11
|
| Rate for Payer: AZCH Complete Medicaid |
$13,229.11
|
| Rate for Payer: Banner UC Health Medicaid |
$13,229.11
|
| Rate for Payer: Mercy Care Medicaid |
$13,229.11
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,146.68
|
|
|
Service Code
|
APR-DRG 5432
|
| Hospital Charge Code |
APRDRG5434
|
| Min. Negotiated Rate |
$4,146.68 |
| Max. Negotiated Rate |
$4,146.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,146.68
|
| Rate for Payer: Allwell Medicaid |
$4,146.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,146.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,146.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,146.68
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,146.68
|
|
|
Service Code
|
APR-DRG 5432
|
| Hospital Charge Code |
APRDRG5432
|
| Min. Negotiated Rate |
$4,146.68 |
| Max. Negotiated Rate |
$4,146.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,146.68
|
| Rate for Payer: Allwell Medicaid |
$4,146.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,146.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,146.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,146.68
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$13,229.11
|
|
|
Service Code
|
APR-DRG 5434
|
| Hospital Charge Code |
APRDRG5432
|
| Min. Negotiated Rate |
$13,229.11 |
| Max. Negotiated Rate |
$13,229.11 |
| Rate for Payer: AHCCCS Medicaid |
$13,229.11
|
| Rate for Payer: Allwell Medicaid |
$13,229.11
|
| Rate for Payer: AZCH Complete Medicaid |
$13,229.11
|
| Rate for Payer: Banner UC Health Medicaid |
$13,229.11
|
| Rate for Payer: Mercy Care Medicaid |
$13,229.11
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,146.68
|
|
|
Service Code
|
APR-DRG 5432
|
| Hospital Charge Code |
APRDRG5431
|
| Min. Negotiated Rate |
$4,146.68 |
| Max. Negotiated Rate |
$4,146.68 |
| Rate for Payer: AHCCCS Medicaid |
$4,146.68
|
| Rate for Payer: Allwell Medicaid |
$4,146.68
|
| Rate for Payer: AZCH Complete Medicaid |
$4,146.68
|
| Rate for Payer: Banner UC Health Medicaid |
$4,146.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,146.68
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$13,229.11
|
|
|
Service Code
|
APR-DRG 5434
|
| Hospital Charge Code |
APRDRG5431
|
| Min. Negotiated Rate |
$13,229.11 |
| Max. Negotiated Rate |
$13,229.11 |
| Rate for Payer: AHCCCS Medicaid |
$13,229.11
|
| Rate for Payer: Allwell Medicaid |
$13,229.11
|
| Rate for Payer: AZCH Complete Medicaid |
$13,229.11
|
| Rate for Payer: Banner UC Health Medicaid |
$13,229.11
|
| Rate for Payer: Mercy Care Medicaid |
$13,229.11
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$3,385.66
|
|
|
Service Code
|
APR-DRG 5431
|
| Hospital Charge Code |
APRDRG5432
|
| Min. Negotiated Rate |
$3,385.66 |
| Max. Negotiated Rate |
$3,385.66 |
| Rate for Payer: AHCCCS Medicaid |
$3,385.66
|
| Rate for Payer: Allwell Medicaid |
$3,385.66
|
| Rate for Payer: AZCH Complete Medicaid |
$3,385.66
|
| Rate for Payer: Banner UC Health Medicaid |
$3,385.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,385.66
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$5,752.18
|
|
|
Service Code
|
APR-DRG 5433
|
| Hospital Charge Code |
APRDRG5432
|
| Min. Negotiated Rate |
$5,752.18 |
| Max. Negotiated Rate |
$5,752.18 |
| Rate for Payer: AHCCCS Medicaid |
$5,752.18
|
| Rate for Payer: Allwell Medicaid |
$5,752.18
|
| Rate for Payer: AZCH Complete Medicaid |
$5,752.18
|
| Rate for Payer: Banner UC Health Medicaid |
$5,752.18
|
| Rate for Payer: Mercy Care Medicaid |
$5,752.18
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$5,752.18
|
|
|
Service Code
|
APR-DRG 5433
|
| Hospital Charge Code |
APRDRG5431
|
| Min. Negotiated Rate |
$5,752.18 |
| Max. Negotiated Rate |
$5,752.18 |
| Rate for Payer: AHCCCS Medicaid |
$5,752.18
|
| Rate for Payer: Allwell Medicaid |
$5,752.18
|
| Rate for Payer: AZCH Complete Medicaid |
$5,752.18
|
| Rate for Payer: Banner UC Health Medicaid |
$5,752.18
|
| Rate for Payer: Mercy Care Medicaid |
$5,752.18
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$5,752.18
|
|
|
Service Code
|
APR-DRG 5433
|
| Hospital Charge Code |
APRDRG5433
|
| Min. Negotiated Rate |
$5,752.18 |
| Max. Negotiated Rate |
$5,752.18 |
| Rate for Payer: AHCCCS Medicaid |
$5,752.18
|
| Rate for Payer: Allwell Medicaid |
$5,752.18
|
| Rate for Payer: AZCH Complete Medicaid |
$5,752.18
|
| Rate for Payer: Banner UC Health Medicaid |
$5,752.18
|
| Rate for Payer: Mercy Care Medicaid |
$5,752.18
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$5,752.18
|
|
|
Service Code
|
APR-DRG 5433
|
| Hospital Charge Code |
APRDRG5434
|
| Min. Negotiated Rate |
$5,752.18 |
| Max. Negotiated Rate |
$5,752.18 |
| Rate for Payer: AHCCCS Medicaid |
$5,752.18
|
| Rate for Payer: Allwell Medicaid |
$5,752.18
|
| Rate for Payer: AZCH Complete Medicaid |
$5,752.18
|
| Rate for Payer: Banner UC Health Medicaid |
$5,752.18
|
| Rate for Payer: Mercy Care Medicaid |
$5,752.18
|
|
|
Abortion With D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$13,229.11
|
|
|
Service Code
|
APR-DRG 5434
|
| Hospital Charge Code |
APRDRG5433
|
| Min. Negotiated Rate |
$13,229.11 |
| Max. Negotiated Rate |
$13,229.11 |
| Rate for Payer: AHCCCS Medicaid |
$13,229.11
|
| Rate for Payer: Allwell Medicaid |
$13,229.11
|
| Rate for Payer: AZCH Complete Medicaid |
$13,229.11
|
| Rate for Payer: Banner UC Health Medicaid |
$13,229.11
|
| Rate for Payer: Mercy Care Medicaid |
$13,229.11
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$10,044.05
|
|
|
Service Code
|
APR-DRG 5644
|
| Hospital Charge Code |
APRDRG5643
|
| Min. Negotiated Rate |
$10,044.05 |
| Max. Negotiated Rate |
$10,044.05 |
| Rate for Payer: AHCCCS Medicaid |
$10,044.05
|
| Rate for Payer: Allwell Medicaid |
$10,044.05
|
| Rate for Payer: AZCH Complete Medicaid |
$10,044.05
|
| Rate for Payer: Banner UC Health Medicaid |
$10,044.05
|
| Rate for Payer: Mercy Care Medicaid |
$10,044.05
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$2,025.64
|
|
|
Service Code
|
APR-DRG 5641
|
| Hospital Charge Code |
APRDRG5641
|
| Min. Negotiated Rate |
$2,025.64 |
| Max. Negotiated Rate |
$2,025.64 |
| Rate for Payer: AHCCCS Medicaid |
$2,025.64
|
| Rate for Payer: Allwell Medicaid |
$2,025.64
|
| Rate for Payer: AZCH Complete Medicaid |
$2,025.64
|
| Rate for Payer: Banner UC Health Medicaid |
$2,025.64
|
| Rate for Payer: Mercy Care Medicaid |
$2,025.64
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$10,044.05
|
|
|
Service Code
|
APR-DRG 5644
|
| Hospital Charge Code |
APRDRG5641
|
| Min. Negotiated Rate |
$10,044.05 |
| Max. Negotiated Rate |
$10,044.05 |
| Rate for Payer: AHCCCS Medicaid |
$10,044.05
|
| Rate for Payer: Allwell Medicaid |
$10,044.05
|
| Rate for Payer: AZCH Complete Medicaid |
$10,044.05
|
| Rate for Payer: Banner UC Health Medicaid |
$10,044.05
|
| Rate for Payer: Mercy Care Medicaid |
$10,044.05
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$2,687.76
|
|
|
Service Code
|
APR-DRG 5642
|
| Hospital Charge Code |
APRDRG5641
|
| Min. Negotiated Rate |
$2,687.76 |
| Max. Negotiated Rate |
$2,687.76 |
| Rate for Payer: AHCCCS Medicaid |
$2,687.76
|
| Rate for Payer: Allwell Medicaid |
$2,687.76
|
| Rate for Payer: AZCH Complete Medicaid |
$2,687.76
|
| Rate for Payer: Banner UC Health Medicaid |
$2,687.76
|
| Rate for Payer: Mercy Care Medicaid |
$2,687.76
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,204.19
|
|
|
Service Code
|
APR-DRG 5643
|
| Hospital Charge Code |
APRDRG5641
|
| Min. Negotiated Rate |
$4,204.19 |
| Max. Negotiated Rate |
$4,204.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,204.19
|
| Rate for Payer: Allwell Medicaid |
$4,204.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,204.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,204.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,204.19
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$10,044.05
|
|
|
Service Code
|
APR-DRG 5644
|
| Hospital Charge Code |
APRDRG5642
|
| Min. Negotiated Rate |
$10,044.05 |
| Max. Negotiated Rate |
$10,044.05 |
| Rate for Payer: AHCCCS Medicaid |
$10,044.05
|
| Rate for Payer: Allwell Medicaid |
$10,044.05
|
| Rate for Payer: AZCH Complete Medicaid |
$10,044.05
|
| Rate for Payer: Banner UC Health Medicaid |
$10,044.05
|
| Rate for Payer: Mercy Care Medicaid |
$10,044.05
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$4,204.19
|
|
|
Service Code
|
APR-DRG 5643
|
| Hospital Charge Code |
APRDRG5643
|
| Min. Negotiated Rate |
$4,204.19 |
| Max. Negotiated Rate |
$4,204.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,204.19
|
| Rate for Payer: Allwell Medicaid |
$4,204.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,204.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,204.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,204.19
|
|
|
Abortion Without D&C, Aspiration Curettage Or Hysterotomy
|
Facility
|
IP
|
$2,687.76
|
|
|
Service Code
|
APR-DRG 5642
|
| Hospital Charge Code |
APRDRG5642
|
| Min. Negotiated Rate |
$2,687.76 |
| Max. Negotiated Rate |
$2,687.76 |
| Rate for Payer: AHCCCS Medicaid |
$2,687.76
|
| Rate for Payer: Allwell Medicaid |
$2,687.76
|
| Rate for Payer: AZCH Complete Medicaid |
$2,687.76
|
| Rate for Payer: Banner UC Health Medicaid |
$2,687.76
|
| Rate for Payer: Mercy Care Medicaid |
$2,687.76
|
|
