|
acyclovir 500 mg/10 mL Sol [CQCH]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
107616107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Aetna of AZ Medicare |
$0.09
|
| Rate for Payer: AHCCCS Medicaid |
$0.10
|
| Rate for Payer: Allwell Medicaid |
$0.10
|
| Rate for Payer: Allwell Medicare |
$0.05
|
| Rate for Payer: Amerigroup Medicare |
$0.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.12
|
| Rate for Payer: AZCH Complete Medicaid |
$0.10
|
| Rate for Payer: AZCH Complete Medicare |
$0.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.10
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of AZ Commercial |
$0.21
|
| Rate for Payer: Copperpoint Commercial |
$0.08
|
| Rate for Payer: Health Net of AZ Commercial |
$0.19
|
| Rate for Payer: Health Net of AZ Medicare |
$0.09
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.10
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.19
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.06
|
|
|
acyclovir 500 mg/10 mL Sol [CQCH]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
107616107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of AZ Commercial |
$0.29
|
| Rate for Payer: Bisbee Police All Plans |
$0.08
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Self Pay Self Pay |
$0.26
|
|
|
ADAPTER AIRWAY CO2 TIDALWAVE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
22354926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
|
|
ADAPTER AIRWAY CO2 TIDALWAVE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
22354926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of AZ Commercial |
$64.80
|
| Rate for Payer: Aetna of AZ Medicare |
$20.16
|
| Rate for Payer: Allwell Medicare |
$10.80
|
| Rate for Payer: Amerigroup Medicare |
$10.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$26.89
|
| Rate for Payer: AZCH Complete Medicare |
$10.80
|
| Rate for Payer: Banner UC Health Medicare |
$10.80
|
| Rate for Payer: Bisbee Police All Plans |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$48.96
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of AZ Commercial |
$50.40
|
| Rate for Payer: Copperpoint Commercial |
$17.82
|
| Rate for Payer: Health Net of AZ Commercial |
$43.20
|
| Rate for Payer: Health Net of AZ Medicare |
$20.16
|
| Rate for Payer: Humana of AZ Medicare |
$10.80
|
| Rate for Payer: Self Pay Self Pay |
$57.60
|
| Rate for Payer: TriWest Medicare |
$10.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$41.98
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.96
|
|
|
ADAPTER ETT CO2 PED/ADULT (TIDAL WAVE)
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
22355405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Aetna of AZ Medicare |
$9.52
|
| Rate for Payer: Allwell Medicare |
$5.10
|
| Rate for Payer: Amerigroup Medicare |
$5.10
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.70
|
| Rate for Payer: AZCH Complete Medicare |
$5.10
|
| Rate for Payer: Banner UC Health Medicare |
$5.10
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$23.12
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cigna of AZ Commercial |
$23.80
|
| Rate for Payer: Copperpoint Commercial |
$8.42
|
| Rate for Payer: Health Net of AZ Commercial |
$20.40
|
| Rate for Payer: Health Net of AZ Medicare |
$9.52
|
| Rate for Payer: Humana of AZ Medicare |
$5.10
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
| Rate for Payer: TriWest Medicare |
$5.10
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.82
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.12
|
|
|
ADAPTER ETT CO2 PED/ADULT (TIDAL WAVE)
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
22355405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of AZ Commercial |
$30.60
|
| Rate for Payer: Bisbee Police All Plans |
$8.84
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Self Pay Self Pay |
$27.20
|
|
|
ADAPTER SAMPLING NC CO2
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
22354925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Aetna of AZ Medicare |
$23.80
|
| Rate for Payer: Allwell Medicare |
$12.75
|
| Rate for Payer: Amerigroup Medicare |
$12.75
|
| Rate for Payer: APIPA Medicare/Medicaid |
$31.75
|
| Rate for Payer: AZCH Complete Medicare |
$12.75
|
| Rate for Payer: Banner UC Health Medicare |
$12.75
|
| Rate for Payer: Bisbee Police All Plans |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of AZ Commercial |
$59.50
|
| Rate for Payer: Copperpoint Commercial |
$21.04
|
| Rate for Payer: Health Net of AZ Commercial |
$51.00
|
| Rate for Payer: Health Net of AZ Medicare |
$23.80
|
| Rate for Payer: Humana of AZ Medicare |
$12.75
|
| Rate for Payer: Self Pay Self Pay |
$68.00
|
| Rate for Payer: TriWest Medicare |
$12.75
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$49.56
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.30
|
|
|
ADAPTER SAMPLING NC CO2
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
22354925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of AZ Commercial |
$76.50
|
| Rate for Payer: Bisbee Police All Plans |
$22.10
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Self Pay Self Pay |
$68.00
|
|
|
ADAPTER SAMPLING SIDESTREAM CO2
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
22354924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Aetna of AZ Medicare |
$19.32
|
| Rate for Payer: Allwell Medicare |
$10.35
|
| Rate for Payer: Amerigroup Medicare |
$10.35
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.77
|
| Rate for Payer: AZCH Complete Medicare |
$10.35
|
| Rate for Payer: Banner UC Health Medicare |
$10.35
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna of AZ Commercial |
$48.30
|
| Rate for Payer: Copperpoint Commercial |
$17.08
|
| Rate for Payer: Health Net of AZ Commercial |
$41.40
|
| Rate for Payer: Health Net of AZ Medicare |
$19.32
|
| Rate for Payer: Humana of AZ Medicare |
$10.35
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
| Rate for Payer: TriWest Medicare |
$10.35
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$40.23
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.42
|
|
|
ADAPTER SAMPLING SIDESTREAM CO2
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
22354924
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna of AZ Commercial |
$62.10
|
| Rate for Payer: Bisbee Police All Plans |
$17.94
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Self Pay Self Pay |
$55.20
|
|
|
ADD IV PUSH NEW MED
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
22283170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
ADD IV PUSH NEW MED
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
22283170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicaid |
$58.00
|
| Rate for Payer: Allwell Medicare |
$40.20
|
| Rate for Payer: Amerigroup Medicare |
$40.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$58.00
|
| Rate for Payer: AZCH Complete Medicare |
$40.20
|
| Rate for Payer: Banner UC Health Medicaid |
$58.00
|
| Rate for Payer: Banner UC Health Medicare |
$40.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$187.60
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$40.20
|
| Rate for Payer: Mercy Care Medicaid |
$58.00
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$40.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
|
ADD IV PUSH SAME MED
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
22283171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
|
|
ADD IV PUSH SAME MED
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
22283171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Aetna of AZ Commercial |
$241.20
|
| Rate for Payer: Aetna of AZ Medicare |
$75.04
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$40.20
|
| Rate for Payer: Amerigroup Medicare |
$40.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.10
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$40.20
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$40.20
|
| Rate for Payer: Bisbee Police All Plans |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$182.24
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cigna of AZ Commercial |
$187.60
|
| Rate for Payer: Copperpoint Commercial |
$66.33
|
| Rate for Payer: Health Net of AZ Commercial |
$160.80
|
| Rate for Payer: Health Net of AZ Medicare |
$75.04
|
| Rate for Payer: Humana of AZ Medicare |
$40.20
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$214.40
|
| Rate for Payer: TriWest Medicare |
$40.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$156.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.24
|
|
|
adenosine 12 mg Inj PFS [CQCH]
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
105909256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of AZ Commercial |
$3.82
|
| Rate for Payer: Aetna of AZ Medicare |
$1.19
|
| Rate for Payer: AHCCCS Medicaid |
$0.98
|
| Rate for Payer: Allwell Medicaid |
$0.98
|
| Rate for Payer: Allwell Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.58
|
| Rate for Payer: AZCH Complete Medicaid |
$0.98
|
| Rate for Payer: AZCH Complete Medicare |
$0.64
|
| Rate for Payer: Banner UC Health Medicaid |
$0.98
|
| Rate for Payer: Banner UC Health Medicare |
$0.64
|
| Rate for Payer: Bisbee Police All Plans |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cigna of AZ Commercial |
$2.76
|
| Rate for Payer: Copperpoint Commercial |
$1.05
|
| Rate for Payer: Health Net of AZ Commercial |
$2.54
|
| Rate for Payer: Health Net of AZ Medicare |
$1.19
|
| Rate for Payer: Humana of AZ Medicare |
$0.64
|
| Rate for Payer: Mercy Care Medicaid |
$0.98
|
| Rate for Payer: Self Pay Self Pay |
$3.39
|
| Rate for Payer: TriWest Medicare |
$0.64
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.47
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.76
|
|
|
adenosine 12 mg Inj PFS [CQCH]
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
105909256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna of AZ Commercial |
$3.82
|
| Rate for Payer: Bisbee Police All Plans |
$1.10
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Self Pay Self Pay |
$3.39
|
|
|
adenosine 6 mg Inj [CQCH]
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
HCPCS J0150
|
| Hospital Charge Code |
105909329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of AZ Commercial |
$4.29
|
| Rate for Payer: Aetna of AZ Medicare |
$1.34
|
| Rate for Payer: Allwell Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1.78
|
| Rate for Payer: AZCH Complete Medicare |
$0.72
|
| Rate for Payer: Banner UC Health Medicare |
$0.72
|
| Rate for Payer: Bisbee Police All Plans |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cigna of AZ Commercial |
$3.10
|
| Rate for Payer: Copperpoint Commercial |
$1.18
|
| Rate for Payer: Health Net of AZ Commercial |
$2.86
|
| Rate for Payer: Health Net of AZ Medicare |
$1.34
|
| Rate for Payer: Humana of AZ Medicare |
$0.72
|
| Rate for Payer: Self Pay Self Pay |
$3.82
|
| Rate for Payer: TriWest Medicare |
$0.72
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.86
|
|
|
adenosine 6 mg Inj [CQCH]
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
HCPCS J0150
|
| Hospital Charge Code |
105909329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna of AZ Commercial |
$4.29
|
| Rate for Payer: Bisbee Police All Plans |
$1.24
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Self Pay Self Pay |
$3.82
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA: DEFECT
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
24049289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,107.34 |
| Max. Negotiated Rate |
$3,833.10 |
| Rate for Payer: Aetna of AZ Commercial |
$3,833.10
|
| Rate for Payer: Bisbee Police All Plans |
$1,107.34
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Self Pay Self Pay |
$3,407.20
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA: DEFECT
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
24049289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$638.85 |
| Max. Negotiated Rate |
$5,107.12 |
| Rate for Payer: Aetna of AZ Commercial |
$3,833.10
|
| Rate for Payer: Aetna of AZ Medicare |
$1,192.52
|
| Rate for Payer: AHCCCS Medicaid |
$5,107.12
|
| Rate for Payer: Allwell Medicaid |
$5,107.12
|
| Rate for Payer: Allwell Medicare |
$638.85
|
| Rate for Payer: Amerigroup Medicare |
$638.85
|
| Rate for Payer: APIPA Medicare/Medicaid |
$1,590.74
|
| Rate for Payer: AZCH Complete Medicaid |
$5,107.12
|
| Rate for Payer: AZCH Complete Medicare |
$638.85
|
| Rate for Payer: Banner UC Health Medicaid |
$5,107.12
|
| Rate for Payer: Banner UC Health Medicare |
$638.85
|
| Rate for Payer: Bisbee Police All Plans |
$1,107.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$2,896.12
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Cash Price |
$3,407.20
|
| Rate for Payer: Cigna of AZ Commercial |
$2,129.50
|
| Rate for Payer: Copperpoint Commercial |
$1,054.10
|
| Rate for Payer: Health Net of AZ Commercial |
$2,555.40
|
| Rate for Payer: Health Net of AZ Medicare |
$1,192.52
|
| Rate for Payer: Humana of AZ Medicare |
$638.85
|
| Rate for Payer: Mercy Care Medicaid |
$5,107.12
|
| Rate for Payer: Self Pay Self Pay |
$3,407.20
|
| Rate for Payer: TriWest Medicare |
$638.85
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$766.62
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$4,436.36
|
|
|
Service Code
|
APR-DRG 7553
|
| Hospital Charge Code |
APRDRG7552
|
| Min. Negotiated Rate |
$4,436.36 |
| Max. Negotiated Rate |
$4,436.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,436.36
|
| Rate for Payer: Allwell Medicaid |
$4,436.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,436.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,436.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,436.36
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$2,871.53
|
|
|
Service Code
|
APR-DRG 7552
|
| Hospital Charge Code |
APRDRG7553
|
| Min. Negotiated Rate |
$2,871.53 |
| Max. Negotiated Rate |
$2,871.53 |
| Rate for Payer: AHCCCS Medicaid |
$2,871.53
|
| Rate for Payer: Allwell Medicaid |
$2,871.53
|
| Rate for Payer: AZCH Complete Medicaid |
$2,871.53
|
| Rate for Payer: Banner UC Health Medicaid |
$2,871.53
|
| Rate for Payer: Mercy Care Medicaid |
$2,871.53
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$4,436.36
|
|
|
Service Code
|
APR-DRG 7553
|
| Hospital Charge Code |
APRDRG7553
|
| Min. Negotiated Rate |
$4,436.36 |
| Max. Negotiated Rate |
$4,436.36 |
| Rate for Payer: AHCCCS Medicaid |
$4,436.36
|
| Rate for Payer: Allwell Medicaid |
$4,436.36
|
| Rate for Payer: AZCH Complete Medicaid |
$4,436.36
|
| Rate for Payer: Banner UC Health Medicaid |
$4,436.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,436.36
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$2,871.53
|
|
|
Service Code
|
APR-DRG 7552
|
| Hospital Charge Code |
APRDRG7552
|
| Min. Negotiated Rate |
$2,871.53 |
| Max. Negotiated Rate |
$2,871.53 |
| Rate for Payer: AHCCCS Medicaid |
$2,871.53
|
| Rate for Payer: Allwell Medicaid |
$2,871.53
|
| Rate for Payer: AZCH Complete Medicaid |
$2,871.53
|
| Rate for Payer: Banner UC Health Medicaid |
$2,871.53
|
| Rate for Payer: Mercy Care Medicaid |
$2,871.53
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
IP
|
$1,892.38
|
|
|
Service Code
|
APR-DRG 7551
|
| Hospital Charge Code |
APRDRG7554
|
| Min. Negotiated Rate |
$1,892.38 |
| Max. Negotiated Rate |
$1,892.38 |
| Rate for Payer: AHCCCS Medicaid |
$1,892.38
|
| Rate for Payer: Allwell Medicaid |
$1,892.38
|
| Rate for Payer: AZCH Complete Medicaid |
$1,892.38
|
| Rate for Payer: Banner UC Health Medicaid |
$1,892.38
|
| Rate for Payer: Mercy Care Medicaid |
$1,892.38
|
|
