|
procainamide 100 mg/mL Sol[CQCH]
|
Facility
|
OP
|
$6.03
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
135202939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna of AZ Commercial |
$5.43
|
| Rate for Payer: Aetna of AZ Medicare |
$1.69
|
| Rate for Payer: Allwell Medicare |
$0.96
|
| Rate for Payer: Amerigroup Medicare |
$0.96
|
| Rate for Payer: APIPA Medicare/Medicaid |
$2.25
|
| Rate for Payer: AZCH Complete Medicare |
$0.96
|
| Rate for Payer: Banner UC Health Medicare |
$0.96
|
| Rate for Payer: Bisbee Police All Plans |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna of AZ Commercial |
$3.92
|
| Rate for Payer: Copperpoint Commercial |
$1.49
|
| Rate for Payer: Health Net of AZ Commercial |
$3.62
|
| Rate for Payer: Health Net of AZ Medicare |
$1.69
|
| Rate for Payer: Humana of AZ Medicare |
$0.96
|
| Rate for Payer: Self Pay Self Pay |
$4.82
|
| Rate for Payer: TriWest Medicare |
$0.96
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3.52
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$1.09
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$29,636.25
|
|
|
Service Code
|
APR-DRG 4034
|
| Hospital Charge Code |
APRDRG4032
|
| Min. Negotiated Rate |
$29,636.25 |
| Max. Negotiated Rate |
$29,636.25 |
| Rate for Payer: AHCCCS Medicaid |
$29,636.25
|
| Rate for Payer: Allwell Medicaid |
$29,636.25
|
| Rate for Payer: AZCH Complete Medicaid |
$29,636.25
|
| Rate for Payer: Banner UC Health Medicaid |
$29,636.25
|
| Rate for Payer: Mercy Care Medicaid |
$29,636.25
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$13,512.47
|
|
|
Service Code
|
APR-DRG 4033
|
| Hospital Charge Code |
APRDRG4033
|
| Min. Negotiated Rate |
$13,512.47 |
| Max. Negotiated Rate |
$13,512.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,512.47
|
| Rate for Payer: Allwell Medicaid |
$13,512.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,512.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,512.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,512.47
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$7,285.44
|
|
|
Service Code
|
APR-DRG 4031
|
| Hospital Charge Code |
APRDRG4032
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: AHCCCS Medicaid |
$7,285.44
|
| Rate for Payer: Allwell Medicaid |
$7,285.44
|
| Rate for Payer: AZCH Complete Medicaid |
$7,285.44
|
| Rate for Payer: Banner UC Health Medicaid |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$7,285.44
|
|
|
Service Code
|
APR-DRG 4031
|
| Hospital Charge Code |
APRDRG4033
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: AHCCCS Medicaid |
$7,285.44
|
| Rate for Payer: Allwell Medicaid |
$7,285.44
|
| Rate for Payer: AZCH Complete Medicaid |
$7,285.44
|
| Rate for Payer: Banner UC Health Medicaid |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$29,636.25
|
|
|
Service Code
|
APR-DRG 4034
|
| Hospital Charge Code |
APRDRG4031
|
| Min. Negotiated Rate |
$29,636.25 |
| Max. Negotiated Rate |
$29,636.25 |
| Rate for Payer: AHCCCS Medicaid |
$29,636.25
|
| Rate for Payer: Allwell Medicaid |
$29,636.25
|
| Rate for Payer: AZCH Complete Medicaid |
$29,636.25
|
| Rate for Payer: Banner UC Health Medicaid |
$29,636.25
|
| Rate for Payer: Mercy Care Medicaid |
$29,636.25
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$7,285.44
|
|
|
Service Code
|
APR-DRG 4031
|
| Hospital Charge Code |
APRDRG4031
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: AHCCCS Medicaid |
$7,285.44
|
| Rate for Payer: Allwell Medicaid |
$7,285.44
|
| Rate for Payer: AZCH Complete Medicaid |
$7,285.44
|
| Rate for Payer: Banner UC Health Medicaid |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$13,512.47
|
|
|
Service Code
|
APR-DRG 4033
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$13,512.47 |
| Max. Negotiated Rate |
$13,512.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,512.47
|
| Rate for Payer: Allwell Medicaid |
$13,512.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,512.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,512.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,512.47
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$29,636.25
|
|
|
Service Code
|
APR-DRG 4034
|
| Hospital Charge Code |
APRDRG4033
|
| Min. Negotiated Rate |
$29,636.25 |
| Max. Negotiated Rate |
$29,636.25 |
| Rate for Payer: AHCCCS Medicaid |
$29,636.25
|
| Rate for Payer: Allwell Medicaid |
$29,636.25
|
| Rate for Payer: AZCH Complete Medicaid |
$29,636.25
|
| Rate for Payer: Banner UC Health Medicaid |
$29,636.25
|
| Rate for Payer: Mercy Care Medicaid |
$29,636.25
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$8,425.22
|
|
|
Service Code
|
APR-DRG 4032
|
| Hospital Charge Code |
APRDRG4033
|
| Min. Negotiated Rate |
$8,425.22 |
| Max. Negotiated Rate |
$8,425.22 |
| Rate for Payer: AHCCCS Medicaid |
$8,425.22
|
| Rate for Payer: Allwell Medicaid |
$8,425.22
|
| Rate for Payer: AZCH Complete Medicaid |
$8,425.22
|
| Rate for Payer: Banner UC Health Medicaid |
$8,425.22
|
| Rate for Payer: Mercy Care Medicaid |
$8,425.22
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$8,425.22
|
|
|
Service Code
|
APR-DRG 4032
|
| Hospital Charge Code |
APRDRG4032
|
| Min. Negotiated Rate |
$8,425.22 |
| Max. Negotiated Rate |
$8,425.22 |
| Rate for Payer: AHCCCS Medicaid |
$8,425.22
|
| Rate for Payer: Allwell Medicaid |
$8,425.22
|
| Rate for Payer: AZCH Complete Medicaid |
$8,425.22
|
| Rate for Payer: Banner UC Health Medicaid |
$8,425.22
|
| Rate for Payer: Mercy Care Medicaid |
$8,425.22
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$8,425.22
|
|
|
Service Code
|
APR-DRG 4032
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$8,425.22 |
| Max. Negotiated Rate |
$8,425.22 |
| Rate for Payer: AHCCCS Medicaid |
$8,425.22
|
| Rate for Payer: Allwell Medicaid |
$8,425.22
|
| Rate for Payer: AZCH Complete Medicaid |
$8,425.22
|
| Rate for Payer: Banner UC Health Medicaid |
$8,425.22
|
| Rate for Payer: Mercy Care Medicaid |
$8,425.22
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$7,285.44
|
|
|
Service Code
|
APR-DRG 4031
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: AHCCCS Medicaid |
$7,285.44
|
| Rate for Payer: Allwell Medicaid |
$7,285.44
|
| Rate for Payer: AZCH Complete Medicaid |
$7,285.44
|
| Rate for Payer: Banner UC Health Medicaid |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$13,512.47
|
|
|
Service Code
|
APR-DRG 4033
|
| Hospital Charge Code |
APRDRG4031
|
| Min. Negotiated Rate |
$13,512.47 |
| Max. Negotiated Rate |
$13,512.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,512.47
|
| Rate for Payer: Allwell Medicaid |
$13,512.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,512.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,512.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,512.47
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$8,425.22
|
|
|
Service Code
|
APR-DRG 4032
|
| Hospital Charge Code |
APRDRG4031
|
| Min. Negotiated Rate |
$8,425.22 |
| Max. Negotiated Rate |
$8,425.22 |
| Rate for Payer: AHCCCS Medicaid |
$8,425.22
|
| Rate for Payer: Allwell Medicaid |
$8,425.22
|
| Rate for Payer: AZCH Complete Medicaid |
$8,425.22
|
| Rate for Payer: Banner UC Health Medicaid |
$8,425.22
|
| Rate for Payer: Mercy Care Medicaid |
$8,425.22
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$13,512.47
|
|
|
Service Code
|
APR-DRG 4033
|
| Hospital Charge Code |
APRDRG4032
|
| Min. Negotiated Rate |
$13,512.47 |
| Max. Negotiated Rate |
$13,512.47 |
| Rate for Payer: AHCCCS Medicaid |
$13,512.47
|
| Rate for Payer: Allwell Medicaid |
$13,512.47
|
| Rate for Payer: AZCH Complete Medicaid |
$13,512.47
|
| Rate for Payer: Banner UC Health Medicaid |
$13,512.47
|
| Rate for Payer: Mercy Care Medicaid |
$13,512.47
|
|
|
Procedures For Obesity
|
Facility
|
IP
|
$29,636.25
|
|
|
Service Code
|
APR-DRG 4034
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$29,636.25 |
| Max. Negotiated Rate |
$29,636.25 |
| Rate for Payer: AHCCCS Medicaid |
$29,636.25
|
| Rate for Payer: Allwell Medicaid |
$29,636.25
|
| Rate for Payer: AZCH Complete Medicaid |
$29,636.25
|
| Rate for Payer: Banner UC Health Medicaid |
$29,636.25
|
| Rate for Payer: Mercy Care Medicaid |
$29,636.25
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: AHCCCS Medicaid |
$19,903.63
|
| Rate for Payer: Allwell Medicaid |
$19,903.63
|
| Rate for Payer: AZCH Complete Medicaid |
$19,903.63
|
| Rate for Payer: Banner UC Health Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: AHCCCS Medicaid |
$11,244.14
|
| Rate for Payer: Allwell Medicaid |
$11,244.14
|
| Rate for Payer: AZCH Complete Medicaid |
$11,244.14
|
| Rate for Payer: Banner UC Health Medicaid |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: AHCCCS Medicaid |
$19,903.63
|
| Rate for Payer: Allwell Medicaid |
$19,903.63
|
| Rate for Payer: AZCH Complete Medicaid |
$19,903.63
|
| Rate for Payer: Banner UC Health Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: AHCCCS Medicaid |
$15,397.83
|
| Rate for Payer: Allwell Medicaid |
$15,397.83
|
| Rate for Payer: AZCH Complete Medicaid |
$15,397.83
|
| Rate for Payer: Banner UC Health Medicaid |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: AHCCCS Medicaid |
$44,695.31
|
| Rate for Payer: Allwell Medicaid |
$44,695.31
|
| Rate for Payer: AZCH Complete Medicaid |
$44,695.31
|
| Rate for Payer: Banner UC Health Medicaid |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: AHCCCS Medicaid |
$44,695.31
|
| Rate for Payer: Allwell Medicaid |
$44,695.31
|
| Rate for Payer: AZCH Complete Medicaid |
$44,695.31
|
| Rate for Payer: Banner UC Health Medicaid |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: AHCCCS Medicaid |
$15,397.83
|
| Rate for Payer: Allwell Medicaid |
$15,397.83
|
| Rate for Payer: AZCH Complete Medicaid |
$15,397.83
|
| Rate for Payer: Banner UC Health Medicaid |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: AHCCCS Medicaid |
$19,903.63
|
| Rate for Payer: Allwell Medicaid |
$19,903.63
|
| Rate for Payer: AZCH Complete Medicaid |
$19,903.63
|
| Rate for Payer: Banner UC Health Medicaid |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
|
