|
REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
24049292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of AZ Commercial |
$73.80
|
| Rate for Payer: Bisbee Police All Plans |
$21.32
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Self Pay Self Pay |
$65.60
|
|
|
REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE D
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
24049292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$260.34 |
| Rate for Payer: Aetna of AZ Commercial |
$73.80
|
| Rate for Payer: Aetna of AZ Medicare |
$22.96
|
| Rate for Payer: AHCCCS Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicaid |
$260.34
|
| Rate for Payer: Allwell Medicare |
$12.30
|
| Rate for Payer: Amerigroup Medicare |
$12.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$30.63
|
| Rate for Payer: AZCH Complete Medicaid |
$260.34
|
| Rate for Payer: AZCH Complete Medicare |
$12.30
|
| Rate for Payer: Banner UC Health Medicaid |
$260.34
|
| Rate for Payer: Banner UC Health Medicare |
$12.30
|
| Rate for Payer: Bisbee Police All Plans |
$21.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$55.76
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cigna of AZ Commercial |
$41.00
|
| Rate for Payer: Copperpoint Commercial |
$20.30
|
| Rate for Payer: Health Net of AZ Commercial |
$49.20
|
| Rate for Payer: Health Net of AZ Medicare |
$22.96
|
| Rate for Payer: Humana of AZ Medicare |
$12.30
|
| Rate for Payer: Mercy Care Medicaid |
$260.34
|
| Rate for Payer: Self Pay Self Pay |
$65.60
|
| Rate for Payer: TriWest Medicare |
$12.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$47.81
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$14.76
|
|
|
REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS - Tech
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
24043293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$2,507.00 |
| Rate for Payer: Aetna of AZ Commercial |
$589.50
|
| Rate for Payer: Aetna of AZ Medicare |
$183.40
|
| Rate for Payer: AHCCCS Medicaid |
$901.86
|
| Rate for Payer: Allwell Medicaid |
$901.86
|
| Rate for Payer: Allwell Medicare |
$98.25
|
| Rate for Payer: Amerigroup Medicare |
$98.25
|
| Rate for Payer: APIPA Medicare/Medicaid |
$244.64
|
| Rate for Payer: AZCH Complete Medicaid |
$901.86
|
| Rate for Payer: AZCH Complete Medicare |
$98.25
|
| Rate for Payer: Banner UC Health Medicaid |
$901.86
|
| Rate for Payer: Banner UC Health Medicare |
$98.25
|
| Rate for Payer: Bisbee Police All Plans |
$170.30
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$445.40
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cigna of AZ Commercial |
$327.50
|
| Rate for Payer: Copperpoint Commercial |
$162.11
|
| Rate for Payer: Health Net of AZ Commercial |
$393.00
|
| Rate for Payer: Health Net of AZ Medicare |
$183.40
|
| Rate for Payer: Humana of AZ Medicare |
$98.25
|
| Rate for Payer: Mercy Care Medicaid |
$901.86
|
| Rate for Payer: Self Pay Self Pay |
$524.00
|
| Rate for Payer: TriWest Medicare |
$98.25
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,507.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$117.90
|
|
|
REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS - Tech
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
24043293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Aetna of AZ Commercial |
$589.50
|
| Rate for Payer: Bisbee Police All Plans |
$170.30
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Self Pay Self Pay |
$524.00
|
|
|
REMOVAL OF IMPLANT; DEEP (EG BURIED WIRE PIN SCREW METAL BAND NAIL ROD OR
|
Facility
|
OP
|
$2,048.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
24043286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$3,436.52 |
| Rate for Payer: Aetna of AZ Commercial |
$1,843.20
|
| Rate for Payer: Aetna of AZ Medicare |
$573.44
|
| Rate for Payer: AHCCCS Medicaid |
$3,436.52
|
| Rate for Payer: Allwell Medicaid |
$3,436.52
|
| Rate for Payer: Allwell Medicare |
$307.20
|
| Rate for Payer: Amerigroup Medicare |
$307.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$764.93
|
| Rate for Payer: AZCH Complete Medicaid |
$3,436.52
|
| Rate for Payer: AZCH Complete Medicare |
$307.20
|
| Rate for Payer: Banner UC Health Medicaid |
$3,436.52
|
| Rate for Payer: Banner UC Health Medicare |
$307.20
|
| Rate for Payer: Bisbee Police All Plans |
$532.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,392.64
|
| Rate for Payer: Cash Price |
$1,638.40
|
| Rate for Payer: Cash Price |
$1,638.40
|
| Rate for Payer: Cigna of AZ Commercial |
$1,024.00
|
| Rate for Payer: Copperpoint Commercial |
$506.88
|
| Rate for Payer: Health Net of AZ Commercial |
$1,228.80
|
| Rate for Payer: Health Net of AZ Medicare |
$573.44
|
| Rate for Payer: Humana of AZ Medicare |
$307.20
|
| Rate for Payer: Mercy Care Medicaid |
$3,436.52
|
| Rate for Payer: Self Pay Self Pay |
$1,638.40
|
| Rate for Payer: TriWest Medicare |
$307.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,373.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$368.64
|
|
|
REMOVAL OF IMPLANT; DEEP (EG BURIED WIRE PIN SCREW METAL BAND NAIL ROD OR
|
Facility
|
IP
|
$2,048.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
24043286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.48 |
| Max. Negotiated Rate |
$1,843.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,843.20
|
| Rate for Payer: Bisbee Police All Plans |
$532.48
|
| Rate for Payer: Cash Price |
$1,638.40
|
| Rate for Payer: Self Pay Self Pay |
$1,638.40
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG BURIED WIRE PIN OR ROD) (SEPARATE
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
24043316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna of AZ Commercial |
$639.00
|
| Rate for Payer: Bisbee Police All Plans |
$184.60
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Self Pay Self Pay |
$568.00
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG BURIED WIRE PIN OR ROD) (SEPARATE
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
24043316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of AZ Commercial |
$639.00
|
| Rate for Payer: Aetna of AZ Medicare |
$198.80
|
| Rate for Payer: AHCCCS Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicaid |
$2,040.16
|
| Rate for Payer: Allwell Medicare |
$106.50
|
| Rate for Payer: Amerigroup Medicare |
$106.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$265.18
|
| Rate for Payer: AZCH Complete Medicaid |
$2,040.16
|
| Rate for Payer: AZCH Complete Medicare |
$106.50
|
| Rate for Payer: Banner UC Health Medicaid |
$2,040.16
|
| Rate for Payer: Banner UC Health Medicare |
$106.50
|
| Rate for Payer: Bisbee Police All Plans |
$184.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$482.80
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna of AZ Commercial |
$355.00
|
| Rate for Payer: Copperpoint Commercial |
$175.72
|
| Rate for Payer: Health Net of AZ Commercial |
$426.00
|
| Rate for Payer: Health Net of AZ Medicare |
$198.80
|
| Rate for Payer: Humana of AZ Medicare |
$106.50
|
| Rate for Payer: Mercy Care Medicaid |
$2,040.16
|
| Rate for Payer: Self Pay Self Pay |
$568.00
|
| Rate for Payer: TriWest Medicare |
$106.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$2,909.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$127.80
|
|
|
Removal of lead
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
27281907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna of AZ Commercial |
$666.00
|
| Rate for Payer: Bisbee Police All Plans |
$192.40
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Self Pay Self Pay |
$592.00
|
|
|
Removal of lead
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
27281907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$4,749.18 |
| Rate for Payer: Aetna of AZ Commercial |
$666.00
|
| Rate for Payer: Aetna of AZ Medicare |
$207.20
|
| Rate for Payer: AHCCCS Medicaid |
$4,749.18
|
| Rate for Payer: Allwell Medicaid |
$4,749.18
|
| Rate for Payer: Allwell Medicare |
$111.00
|
| Rate for Payer: Amerigroup Medicare |
$111.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$276.39
|
| Rate for Payer: AZCH Complete Medicaid |
$4,749.18
|
| Rate for Payer: AZCH Complete Medicare |
$111.00
|
| Rate for Payer: Banner UC Health Medicaid |
$4,749.18
|
| Rate for Payer: Banner UC Health Medicare |
$111.00
|
| Rate for Payer: Bisbee Police All Plans |
$192.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$503.20
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cigna of AZ Commercial |
$370.00
|
| Rate for Payer: Copperpoint Commercial |
$183.15
|
| Rate for Payer: Health Net of AZ Commercial |
$444.00
|
| Rate for Payer: Health Net of AZ Medicare |
$207.20
|
| Rate for Payer: Humana of AZ Medicare |
$111.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,749.18
|
| Rate for Payer: Self Pay Self Pay |
$592.00
|
| Rate for Payer: TriWest Medicare |
$111.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$133.20
|
|
|
Removal /revision of generator
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
27267840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna of AZ Commercial |
$619.20
|
| Rate for Payer: Bisbee Police All Plans |
$178.88
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Self Pay Self Pay |
$550.40
|
|
|
Removal /revision of generator
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
27267840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$4,749.18 |
| Rate for Payer: Aetna of AZ Commercial |
$619.20
|
| Rate for Payer: Aetna of AZ Medicare |
$192.64
|
| Rate for Payer: AHCCCS Medicaid |
$4,749.18
|
| Rate for Payer: Allwell Medicaid |
$4,749.18
|
| Rate for Payer: Allwell Medicare |
$103.20
|
| Rate for Payer: Amerigroup Medicare |
$103.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$256.97
|
| Rate for Payer: AZCH Complete Medicaid |
$4,749.18
|
| Rate for Payer: AZCH Complete Medicare |
$103.20
|
| Rate for Payer: Banner UC Health Medicaid |
$4,749.18
|
| Rate for Payer: Banner UC Health Medicare |
$103.20
|
| Rate for Payer: Bisbee Police All Plans |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$467.84
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cigna of AZ Commercial |
$344.00
|
| Rate for Payer: Copperpoint Commercial |
$170.28
|
| Rate for Payer: Health Net of AZ Commercial |
$412.80
|
| Rate for Payer: Health Net of AZ Medicare |
$192.64
|
| Rate for Payer: Humana of AZ Medicare |
$103.20
|
| Rate for Payer: Mercy Care Medicaid |
$4,749.18
|
| Rate for Payer: Self Pay Self Pay |
$550.40
|
| Rate for Payer: TriWest Medicare |
$103.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$3,914.00
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$123.84
|
|
|
REMOVER STAPLE PRECISE 3M
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
22540633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
|
|
REMOVER STAPLE PRECISE 3M
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
22540633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of AZ Commercial |
$14.40
|
| Rate for Payer: Aetna of AZ Medicare |
$4.48
|
| Rate for Payer: Allwell Medicare |
$2.40
|
| Rate for Payer: Amerigroup Medicare |
$2.40
|
| Rate for Payer: APIPA Medicare/Medicaid |
$5.98
|
| Rate for Payer: AZCH Complete Medicare |
$2.40
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Bisbee Police All Plans |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cigna of AZ Commercial |
$11.20
|
| Rate for Payer: Copperpoint Commercial |
$3.96
|
| Rate for Payer: Health Net of AZ Commercial |
$9.60
|
| Rate for Payer: Health Net of AZ Medicare |
$4.48
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Self Pay Self Pay |
$12.80
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$9.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$2.88
|
|
|
REMOVER STAPLE PROXIMATE
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
22355173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Aetna of AZ Medicare |
$10.36
|
| Rate for Payer: Allwell Medicare |
$5.55
|
| Rate for Payer: Amerigroup Medicare |
$5.55
|
| Rate for Payer: APIPA Medicare/Medicaid |
$13.82
|
| Rate for Payer: AZCH Complete Medicare |
$5.55
|
| Rate for Payer: Banner UC Health Medicare |
$5.55
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cigna of AZ Commercial |
$25.90
|
| Rate for Payer: Copperpoint Commercial |
$9.16
|
| Rate for Payer: Health Net of AZ Commercial |
$22.20
|
| Rate for Payer: Health Net of AZ Medicare |
$10.36
|
| Rate for Payer: Humana of AZ Medicare |
$5.55
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
| Rate for Payer: TriWest Medicare |
$5.55
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$21.57
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$6.66
|
|
|
REMOVER STAPLE PROXIMATE
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
22355173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Bisbee Police All Plans |
$9.62
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Self Pay Self Pay |
$29.60
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: AHCCCS Medicaid |
$6,833.04
|
| Rate for Payer: Allwell Medicaid |
$6,833.04
|
| Rate for Payer: AZCH Complete Medicaid |
$6,833.04
|
| Rate for Payer: Banner UC Health Medicaid |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,643.52
|
| Rate for Payer: Allwell Medicaid |
$16,643.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,643.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: AHCCCS Medicaid |
$29,825.63
|
| Rate for Payer: Allwell Medicaid |
$29,825.63
|
| Rate for Payer: AZCH Complete Medicaid |
$29,825.63
|
| Rate for Payer: Banner UC Health Medicaid |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,643.52
|
| Rate for Payer: Allwell Medicaid |
$16,643.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,643.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: AHCCCS Medicaid |
$10,436.13
|
| Rate for Payer: Allwell Medicaid |
$10,436.13
|
| Rate for Payer: AZCH Complete Medicaid |
$10,436.13
|
| Rate for Payer: Banner UC Health Medicaid |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: AHCCCS Medicaid |
$10,436.13
|
| Rate for Payer: Allwell Medicaid |
$10,436.13
|
| Rate for Payer: AZCH Complete Medicaid |
$10,436.13
|
| Rate for Payer: Banner UC Health Medicaid |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: AHCCCS Medicaid |
$29,825.63
|
| Rate for Payer: Allwell Medicaid |
$29,825.63
|
| Rate for Payer: AZCH Complete Medicaid |
$29,825.63
|
| Rate for Payer: Banner UC Health Medicaid |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: AHCCCS Medicaid |
$6,833.04
|
| Rate for Payer: Allwell Medicaid |
$6,833.04
|
| Rate for Payer: AZCH Complete Medicaid |
$6,833.04
|
| Rate for Payer: Banner UC Health Medicaid |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,643.52
|
| Rate for Payer: Allwell Medicaid |
$16,643.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,643.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
|
