|
Penis, Testes And Scrotal Procedures
|
Facility
|
IP
|
$13,713.07
|
|
|
Service Code
|
APR-DRG 4833
|
| Hospital Charge Code |
APRDRG4834
|
| Min. Negotiated Rate |
$13,713.07 |
| Max. Negotiated Rate |
$13,713.07 |
| Rate for Payer: AHCCCS Medicaid |
$13,713.07
|
| Rate for Payer: Allwell Medicaid |
$13,713.07
|
| Rate for Payer: AZCH Complete Medicaid |
$13,713.07
|
| Rate for Payer: Banner UC Health Medicaid |
$13,713.07
|
| Rate for Payer: Mercy Care Medicaid |
$13,713.07
|
|
|
Penis, Testes And Scrotal Procedures
|
Facility
|
IP
|
$24,699.10
|
|
|
Service Code
|
APR-DRG 4834
|
| Hospital Charge Code |
APRDRG4834
|
| Min. Negotiated Rate |
$24,699.10 |
| Max. Negotiated Rate |
$24,699.10 |
| Rate for Payer: AHCCCS Medicaid |
$24,699.10
|
| Rate for Payer: Allwell Medicaid |
$24,699.10
|
| Rate for Payer: AZCH Complete Medicaid |
$24,699.10
|
| Rate for Payer: Banner UC Health Medicaid |
$24,699.10
|
| Rate for Payer: Mercy Care Medicaid |
$24,699.10
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: AHCCCS Medicaid |
$7,366.80
|
| Rate for Payer: Allwell Medicaid |
$7,366.80
|
| Rate for Payer: AZCH Complete Medicaid |
$7,366.80
|
| Rate for Payer: Banner UC Health Medicaid |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2414
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: AHCCCS Medicaid |
$5,002.38
|
| Rate for Payer: Allwell Medicaid |
$5,002.38
|
| Rate for Payer: AZCH Complete Medicaid |
$5,002.38
|
| Rate for Payer: Banner UC Health Medicaid |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$16,030.50
|
|
|
Service Code
|
APR-DRG 2414
|
| Hospital Charge Code |
APRDRG2414
|
| Min. Negotiated Rate |
$16,030.50 |
| Max. Negotiated Rate |
$16,030.50 |
| Rate for Payer: AHCCCS Medicaid |
$16,030.50
|
| Rate for Payer: Allwell Medicaid |
$16,030.50
|
| Rate for Payer: AZCH Complete Medicaid |
$16,030.50
|
| Rate for Payer: Banner UC Health Medicaid |
$16,030.50
|
| Rate for Payer: Mercy Care Medicaid |
$16,030.50
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$4,103.19
|
|
|
Service Code
|
APR-DRG 2411
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$4,103.19 |
| Max. Negotiated Rate |
$4,103.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,103.19
|
| Rate for Payer: Allwell Medicaid |
$4,103.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,103.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,103.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,103.19
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$4,103.19
|
|
|
Service Code
|
APR-DRG 2411
|
| Hospital Charge Code |
APRDRG2414
|
| Min. Negotiated Rate |
$4,103.19 |
| Max. Negotiated Rate |
$4,103.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,103.19
|
| Rate for Payer: Allwell Medicaid |
$4,103.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,103.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,103.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,103.19
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2414
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: AHCCCS Medicaid |
$7,366.80
|
| Rate for Payer: Allwell Medicaid |
$7,366.80
|
| Rate for Payer: AZCH Complete Medicaid |
$7,366.80
|
| Rate for Payer: Banner UC Health Medicaid |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: AHCCCS Medicaid |
$5,002.38
|
| Rate for Payer: Allwell Medicaid |
$5,002.38
|
| Rate for Payer: AZCH Complete Medicaid |
$5,002.38
|
| Rate for Payer: Banner UC Health Medicaid |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$4,103.19
|
|
|
Service Code
|
APR-DRG 2411
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$4,103.19 |
| Max. Negotiated Rate |
$4,103.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,103.19
|
| Rate for Payer: Allwell Medicaid |
$4,103.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,103.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,103.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,103.19
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: AHCCCS Medicaid |
$7,366.80
|
| Rate for Payer: Allwell Medicaid |
$7,366.80
|
| Rate for Payer: AZCH Complete Medicaid |
$7,366.80
|
| Rate for Payer: Banner UC Health Medicaid |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$16,030.50
|
|
|
Service Code
|
APR-DRG 2414
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$16,030.50 |
| Max. Negotiated Rate |
$16,030.50 |
| Rate for Payer: AHCCCS Medicaid |
$16,030.50
|
| Rate for Payer: Allwell Medicaid |
$16,030.50
|
| Rate for Payer: AZCH Complete Medicaid |
$16,030.50
|
| Rate for Payer: Banner UC Health Medicaid |
$16,030.50
|
| Rate for Payer: Mercy Care Medicaid |
$16,030.50
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$4,103.19
|
|
|
Service Code
|
APR-DRG 2411
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$4,103.19 |
| Max. Negotiated Rate |
$4,103.19 |
| Rate for Payer: AHCCCS Medicaid |
$4,103.19
|
| Rate for Payer: Allwell Medicaid |
$4,103.19
|
| Rate for Payer: AZCH Complete Medicaid |
$4,103.19
|
| Rate for Payer: Banner UC Health Medicaid |
$4,103.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,103.19
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: AHCCCS Medicaid |
$5,002.38
|
| Rate for Payer: Allwell Medicaid |
$5,002.38
|
| Rate for Payer: AZCH Complete Medicaid |
$5,002.38
|
| Rate for Payer: Banner UC Health Medicaid |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: AHCCCS Medicaid |
$7,366.80
|
| Rate for Payer: Allwell Medicaid |
$7,366.80
|
| Rate for Payer: AZCH Complete Medicaid |
$7,366.80
|
| Rate for Payer: Banner UC Health Medicaid |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$16,030.50
|
|
|
Service Code
|
APR-DRG 2414
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$16,030.50 |
| Max. Negotiated Rate |
$16,030.50 |
| Rate for Payer: AHCCCS Medicaid |
$16,030.50
|
| Rate for Payer: Allwell Medicaid |
$16,030.50
|
| Rate for Payer: AZCH Complete Medicaid |
$16,030.50
|
| Rate for Payer: Banner UC Health Medicaid |
$16,030.50
|
| Rate for Payer: Mercy Care Medicaid |
$16,030.50
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$16,030.50
|
|
|
Service Code
|
APR-DRG 2414
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$16,030.50 |
| Max. Negotiated Rate |
$16,030.50 |
| Rate for Payer: AHCCCS Medicaid |
$16,030.50
|
| Rate for Payer: Allwell Medicaid |
$16,030.50
|
| Rate for Payer: AZCH Complete Medicaid |
$16,030.50
|
| Rate for Payer: Banner UC Health Medicaid |
$16,030.50
|
| Rate for Payer: Mercy Care Medicaid |
$16,030.50
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: AHCCCS Medicaid |
$5,002.38
|
| Rate for Payer: Allwell Medicaid |
$5,002.38
|
| Rate for Payer: AZCH Complete Medicaid |
$5,002.38
|
| Rate for Payer: Banner UC Health Medicaid |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
|
|
PERCUTANEOUS 18GA ACCESS NEEDLE
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
22354210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Aetna of AZ Medicare |
$22.68
|
| Rate for Payer: Allwell Medicare |
$12.15
|
| Rate for Payer: Amerigroup Medicare |
$12.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$30.25
|
| Rate for Payer: AZCH Complete Medicare |
$12.15
|
| Rate for Payer: Banner UC Health Medicare |
$12.15
|
| Rate for Payer: Bisbee Police All Plans |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$55.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of AZ Commercial |
$56.70
|
| Rate for Payer: Copperpoint Commercial |
$20.05
|
| Rate for Payer: Health Net of AZ Commercial |
$48.60
|
| Rate for Payer: Health Net of AZ Medicare |
$22.68
|
| Rate for Payer: Humana of AZ Medicare |
$12.15
|
| Rate for Payer: Self Pay Self Pay |
$64.80
|
| Rate for Payer: TriWest Medicare |
$12.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$47.22
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.58
|
|
|
PERCUTANEOUS 18GA ACCESS NEEDLE
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
22354210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Bisbee Police All Plans |
$21.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Self Pay Self Pay |
$64.80
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1741
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: AHCCCS Medicaid |
$17,279.69
|
| Rate for Payer: Allwell Medicaid |
$17,279.69
|
| Rate for Payer: AZCH Complete Medicaid |
$17,279.69
|
| Rate for Payer: Banner UC Health Medicaid |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: AHCCCS Medicaid |
$17,279.69
|
| Rate for Payer: Allwell Medicaid |
$17,279.69
|
| Rate for Payer: AZCH Complete Medicaid |
$17,279.69
|
| Rate for Payer: Banner UC Health Medicaid |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1744
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: AHCCCS Medicaid |
$17,279.69
|
| Rate for Payer: Allwell Medicaid |
$17,279.69
|
| Rate for Payer: AZCH Complete Medicaid |
$17,279.69
|
| Rate for Payer: Banner UC Health Medicaid |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$13,351.15
|
|
|
Service Code
|
APR-DRG 1742
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$13,351.15 |
| Max. Negotiated Rate |
$13,351.15 |
| Rate for Payer: AHCCCS Medicaid |
$13,351.15
|
| Rate for Payer: Allwell Medicaid |
$13,351.15
|
| Rate for Payer: AZCH Complete Medicaid |
$13,351.15
|
| Rate for Payer: Banner UC Health Medicaid |
$13,351.15
|
| Rate for Payer: Mercy Care Medicaid |
$13,351.15
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$12,050.75
|
|
|
Service Code
|
APR-DRG 1741
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$12,050.75 |
| Max. Negotiated Rate |
$12,050.75 |
| Rate for Payer: AHCCCS Medicaid |
$12,050.75
|
| Rate for Payer: Allwell Medicaid |
$12,050.75
|
| Rate for Payer: AZCH Complete Medicaid |
$12,050.75
|
| Rate for Payer: Banner UC Health Medicaid |
$12,050.75
|
| Rate for Payer: Mercy Care Medicaid |
$12,050.75
|
|
