|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
Facility
|
IP
|
$26,175.55
|
|
|
Service Code
|
APR-DRG 0303
|
| Hospital Charge Code |
APRDRG0301
|
| Min. Negotiated Rate |
$26,175.55 |
| Max. Negotiated Rate |
$26,175.55 |
| Rate for Payer: AHCCCS Medicaid |
$26,175.55
|
| Rate for Payer: Allwell Medicaid |
$26,175.55
|
| Rate for Payer: AZCH Complete Medicaid |
$26,175.55
|
| Rate for Payer: Banner UC Health Medicaid |
$26,175.55
|
| Rate for Payer: Mercy Care Medicaid |
$26,175.55
|
|
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
Facility
|
IP
|
$13,076.90
|
|
|
Service Code
|
APR-DRG 0301
|
| Hospital Charge Code |
APRDRG0301
|
| Min. Negotiated Rate |
$13,076.90 |
| Max. Negotiated Rate |
$13,076.90 |
| Rate for Payer: AHCCCS Medicaid |
$13,076.90
|
| Rate for Payer: Allwell Medicaid |
$13,076.90
|
| Rate for Payer: AZCH Complete Medicaid |
$13,076.90
|
| Rate for Payer: Banner UC Health Medicaid |
$13,076.90
|
| Rate for Payer: Mercy Care Medicaid |
$13,076.90
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE PHALANX OR PHALANGES
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
24043336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.10 |
| Max. Negotiated Rate |
$1,066.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,066.50
|
| Rate for Payer: Bisbee Police All Plans |
$308.10
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Self Pay Self Pay |
$948.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE PHALANX OR PHALANGES
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
24043336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,066.50
|
| Rate for Payer: Aetna of AZ Medicare |
$331.80
|
| Rate for Payer: AHCCCS Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicare |
$189.60
|
| Rate for Payer: Amerigroup Medicare |
$189.60
|
| Rate for Payer: APIPA Medicare/Medicaid |
$442.60
|
| Rate for Payer: AZCH Complete Medicaid |
$2,052.04
|
| Rate for Payer: AZCH Complete Medicare |
$189.60
|
| Rate for Payer: Banner UC Health Medicaid |
$2,052.04
|
| Rate for Payer: Banner UC Health Medicare |
$189.60
|
| Rate for Payer: Bisbee Police All Plans |
$308.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$805.80
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna of AZ Commercial |
$592.50
|
| Rate for Payer: Copperpoint Commercial |
$293.29
|
| Rate for Payer: Health Net of AZ Commercial |
$711.00
|
| Rate for Payer: Health Net of AZ Medicare |
$331.80
|
| Rate for Payer: Humana of AZ Medicare |
$189.60
|
| Rate for Payer: Mercy Care Medicaid |
$2,052.04
|
| Rate for Payer: Self Pay Self Pay |
$948.00
|
| Rate for Payer: TriWest Medicare |
$189.60
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$213.30
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE WITH MANIPULATION EACH - Tech
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
24043299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$3,373.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,533.60
|
| Rate for Payer: Aetna of AZ Medicare |
$477.12
|
| Rate for Payer: AHCCCS Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicaid |
$2,052.04
|
| Rate for Payer: Allwell Medicare |
$272.64
|
| Rate for Payer: Amerigroup Medicare |
$272.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$636.44
|
| Rate for Payer: AZCH Complete Medicaid |
$2,052.04
|
| Rate for Payer: AZCH Complete Medicare |
$272.64
|
| Rate for Payer: Banner UC Health Medicaid |
$2,052.04
|
| Rate for Payer: Banner UC Health Medicare |
$272.64
|
| Rate for Payer: Bisbee Police All Plans |
$443.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,158.72
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cigna of AZ Commercial |
$852.00
|
| Rate for Payer: Copperpoint Commercial |
$421.74
|
| Rate for Payer: Health Net of AZ Commercial |
$1,022.40
|
| Rate for Payer: Health Net of AZ Medicare |
$477.12
|
| Rate for Payer: Humana of AZ Medicare |
$272.64
|
| Rate for Payer: Mercy Care Medicaid |
$2,052.04
|
| Rate for Payer: Self Pay Self Pay |
$1,363.20
|
| Rate for Payer: TriWest Medicare |
$272.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$306.72
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE WITH MANIPULATION EACH - Tech
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
24043299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$443.04 |
| Max. Negotiated Rate |
$1,533.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,533.60
|
| Rate for Payer: Bisbee Police All Plans |
$443.04
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Self Pay Self Pay |
$1,363.20
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$28,283.25
|
|
|
Service Code
|
APR-DRG 1832
|
| Hospital Charge Code |
APRDRG1831
|
| Min. Negotiated Rate |
$28,283.25 |
| Max. Negotiated Rate |
$28,283.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,283.25
|
| Rate for Payer: Allwell Medicaid |
$28,283.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,283.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,283.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,283.25
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$26,889.57
|
|
|
Service Code
|
APR-DRG 1831
|
| Hospital Charge Code |
APRDRG1834
|
| Min. Negotiated Rate |
$26,889.57 |
| Max. Negotiated Rate |
$26,889.57 |
| Rate for Payer: AHCCCS Medicaid |
$26,889.57
|
| Rate for Payer: Allwell Medicaid |
$26,889.57
|
| Rate for Payer: AZCH Complete Medicaid |
$26,889.57
|
| Rate for Payer: Banner UC Health Medicaid |
$26,889.57
|
| Rate for Payer: Mercy Care Medicaid |
$26,889.57
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$28,283.25
|
|
|
Service Code
|
APR-DRG 1832
|
| Hospital Charge Code |
APRDRG1832
|
| Min. Negotiated Rate |
$28,283.25 |
| Max. Negotiated Rate |
$28,283.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,283.25
|
| Rate for Payer: Allwell Medicaid |
$28,283.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,283.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,283.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,283.25
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$48,903.71
|
|
|
Service Code
|
APR-DRG 1834
|
| Hospital Charge Code |
APRDRG1834
|
| Min. Negotiated Rate |
$48,903.71 |
| Max. Negotiated Rate |
$48,903.71 |
| Rate for Payer: AHCCCS Medicaid |
$48,903.71
|
| Rate for Payer: Allwell Medicaid |
$48,903.71
|
| Rate for Payer: AZCH Complete Medicaid |
$48,903.71
|
| Rate for Payer: Banner UC Health Medicaid |
$48,903.71
|
| Rate for Payer: Mercy Care Medicaid |
$48,903.71
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$33,632.13
|
|
|
Service Code
|
APR-DRG 1833
|
| Hospital Charge Code |
APRDRG1833
|
| Min. Negotiated Rate |
$33,632.13 |
| Max. Negotiated Rate |
$33,632.13 |
| Rate for Payer: AHCCCS Medicaid |
$33,632.13
|
| Rate for Payer: Allwell Medicaid |
$33,632.13
|
| Rate for Payer: AZCH Complete Medicaid |
$33,632.13
|
| Rate for Payer: Banner UC Health Medicaid |
$33,632.13
|
| Rate for Payer: Mercy Care Medicaid |
$33,632.13
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$26,889.57
|
|
|
Service Code
|
APR-DRG 1831
|
| Hospital Charge Code |
APRDRG1831
|
| Min. Negotiated Rate |
$26,889.57 |
| Max. Negotiated Rate |
$26,889.57 |
| Rate for Payer: AHCCCS Medicaid |
$26,889.57
|
| Rate for Payer: Allwell Medicaid |
$26,889.57
|
| Rate for Payer: AZCH Complete Medicaid |
$26,889.57
|
| Rate for Payer: Banner UC Health Medicaid |
$26,889.57
|
| Rate for Payer: Mercy Care Medicaid |
$26,889.57
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$48,903.71
|
|
|
Service Code
|
APR-DRG 1834
|
| Hospital Charge Code |
APRDRG1833
|
| Min. Negotiated Rate |
$48,903.71 |
| Max. Negotiated Rate |
$48,903.71 |
| Rate for Payer: AHCCCS Medicaid |
$48,903.71
|
| Rate for Payer: Allwell Medicaid |
$48,903.71
|
| Rate for Payer: AZCH Complete Medicaid |
$48,903.71
|
| Rate for Payer: Banner UC Health Medicaid |
$48,903.71
|
| Rate for Payer: Mercy Care Medicaid |
$48,903.71
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$33,632.13
|
|
|
Service Code
|
APR-DRG 1833
|
| Hospital Charge Code |
APRDRG1831
|
| Min. Negotiated Rate |
$33,632.13 |
| Max. Negotiated Rate |
$33,632.13 |
| Rate for Payer: AHCCCS Medicaid |
$33,632.13
|
| Rate for Payer: Allwell Medicaid |
$33,632.13
|
| Rate for Payer: AZCH Complete Medicaid |
$33,632.13
|
| Rate for Payer: Banner UC Health Medicaid |
$33,632.13
|
| Rate for Payer: Mercy Care Medicaid |
$33,632.13
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$28,283.25
|
|
|
Service Code
|
APR-DRG 1832
|
| Hospital Charge Code |
APRDRG1834
|
| Min. Negotiated Rate |
$28,283.25 |
| Max. Negotiated Rate |
$28,283.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,283.25
|
| Rate for Payer: Allwell Medicaid |
$28,283.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,283.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,283.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,283.25
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$26,889.57
|
|
|
Service Code
|
APR-DRG 1831
|
| Hospital Charge Code |
APRDRG1833
|
| Min. Negotiated Rate |
$26,889.57 |
| Max. Negotiated Rate |
$26,889.57 |
| Rate for Payer: AHCCCS Medicaid |
$26,889.57
|
| Rate for Payer: Allwell Medicaid |
$26,889.57
|
| Rate for Payer: AZCH Complete Medicaid |
$26,889.57
|
| Rate for Payer: Banner UC Health Medicaid |
$26,889.57
|
| Rate for Payer: Mercy Care Medicaid |
$26,889.57
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$28,283.25
|
|
|
Service Code
|
APR-DRG 1832
|
| Hospital Charge Code |
APRDRG1833
|
| Min. Negotiated Rate |
$28,283.25 |
| Max. Negotiated Rate |
$28,283.25 |
| Rate for Payer: AHCCCS Medicaid |
$28,283.25
|
| Rate for Payer: Allwell Medicaid |
$28,283.25
|
| Rate for Payer: AZCH Complete Medicaid |
$28,283.25
|
| Rate for Payer: Banner UC Health Medicaid |
$28,283.25
|
| Rate for Payer: Mercy Care Medicaid |
$28,283.25
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$26,889.57
|
|
|
Service Code
|
APR-DRG 1831
|
| Hospital Charge Code |
APRDRG1832
|
| Min. Negotiated Rate |
$26,889.57 |
| Max. Negotiated Rate |
$26,889.57 |
| Rate for Payer: AHCCCS Medicaid |
$26,889.57
|
| Rate for Payer: Allwell Medicaid |
$26,889.57
|
| Rate for Payer: AZCH Complete Medicaid |
$26,889.57
|
| Rate for Payer: Banner UC Health Medicaid |
$26,889.57
|
| Rate for Payer: Mercy Care Medicaid |
$26,889.57
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$33,632.13
|
|
|
Service Code
|
APR-DRG 1833
|
| Hospital Charge Code |
APRDRG1832
|
| Min. Negotiated Rate |
$33,632.13 |
| Max. Negotiated Rate |
$33,632.13 |
| Rate for Payer: AHCCCS Medicaid |
$33,632.13
|
| Rate for Payer: Allwell Medicaid |
$33,632.13
|
| Rate for Payer: AZCH Complete Medicaid |
$33,632.13
|
| Rate for Payer: Banner UC Health Medicaid |
$33,632.13
|
| Rate for Payer: Mercy Care Medicaid |
$33,632.13
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$48,903.71
|
|
|
Service Code
|
APR-DRG 1834
|
| Hospital Charge Code |
APRDRG1831
|
| Min. Negotiated Rate |
$48,903.71 |
| Max. Negotiated Rate |
$48,903.71 |
| Rate for Payer: AHCCCS Medicaid |
$48,903.71
|
| Rate for Payer: Allwell Medicaid |
$48,903.71
|
| Rate for Payer: AZCH Complete Medicaid |
$48,903.71
|
| Rate for Payer: Banner UC Health Medicaid |
$48,903.71
|
| Rate for Payer: Mercy Care Medicaid |
$48,903.71
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$48,903.71
|
|
|
Service Code
|
APR-DRG 1834
|
| Hospital Charge Code |
APRDRG1832
|
| Min. Negotiated Rate |
$48,903.71 |
| Max. Negotiated Rate |
$48,903.71 |
| Rate for Payer: AHCCCS Medicaid |
$48,903.71
|
| Rate for Payer: Allwell Medicaid |
$48,903.71
|
| Rate for Payer: AZCH Complete Medicaid |
$48,903.71
|
| Rate for Payer: Banner UC Health Medicaid |
$48,903.71
|
| Rate for Payer: Mercy Care Medicaid |
$48,903.71
|
|
|
Percutaneous Structural Cardiac Procedures
|
Facility
|
IP
|
$33,632.13
|
|
|
Service Code
|
APR-DRG 1833
|
| Hospital Charge Code |
APRDRG1834
|
| Min. Negotiated Rate |
$33,632.13 |
| Max. Negotiated Rate |
$33,632.13 |
| Rate for Payer: AHCCCS Medicaid |
$33,632.13
|
| Rate for Payer: Allwell Medicaid |
$33,632.13
|
| Rate for Payer: AZCH Complete Medicaid |
$33,632.13
|
| Rate for Payer: Banner UC Health Medicaid |
$33,632.13
|
| Rate for Payer: Mercy Care Medicaid |
$33,632.13
|
|
|
Peripheral And Other Vascular Disorders
|
Facility
|
IP
|
$3,568.72
|
|
|
Service Code
|
APR-DRG 1971
|
| Hospital Charge Code |
APRDRG1972
|
| Min. Negotiated Rate |
$3,568.72 |
| Max. Negotiated Rate |
$3,568.72 |
| Rate for Payer: AHCCCS Medicaid |
$3,568.72
|
| Rate for Payer: Allwell Medicaid |
$3,568.72
|
| Rate for Payer: AZCH Complete Medicaid |
$3,568.72
|
| Rate for Payer: Banner UC Health Medicaid |
$3,568.72
|
| Rate for Payer: Mercy Care Medicaid |
$3,568.72
|
|
|
Peripheral And Other Vascular Disorders
|
Facility
|
IP
|
$3,568.72
|
|
|
Service Code
|
APR-DRG 1971
|
| Hospital Charge Code |
APRDRG1971
|
| Min. Negotiated Rate |
$3,568.72 |
| Max. Negotiated Rate |
$3,568.72 |
| Rate for Payer: AHCCCS Medicaid |
$3,568.72
|
| Rate for Payer: Allwell Medicaid |
$3,568.72
|
| Rate for Payer: AZCH Complete Medicaid |
$3,568.72
|
| Rate for Payer: Banner UC Health Medicaid |
$3,568.72
|
| Rate for Payer: Mercy Care Medicaid |
$3,568.72
|
|
|
Peripheral And Other Vascular Disorders
|
Facility
|
IP
|
$6,431.84
|
|
|
Service Code
|
APR-DRG 1973
|
| Hospital Charge Code |
APRDRG1971
|
| Min. Negotiated Rate |
$6,431.84 |
| Max. Negotiated Rate |
$6,431.84 |
| Rate for Payer: AHCCCS Medicaid |
$6,431.84
|
| Rate for Payer: Allwell Medicaid |
$6,431.84
|
| Rate for Payer: AZCH Complete Medicaid |
$6,431.84
|
| Rate for Payer: Banner UC Health Medicaid |
$6,431.84
|
| Rate for Payer: Mercy Care Medicaid |
$6,431.84
|
|
