|
SHIGA-TOXIN 2 AG
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
|
|
SHIGA-TOXIN 2 AG
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
22272338
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Aetna of AZ Medicare |
$24.36
|
| Rate for Payer: AHCCCS Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicaid |
$16.07
|
| Rate for Payer: Allwell Medicare |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.49
|
| Rate for Payer: AZCH Complete Medicaid |
$16.07
|
| Rate for Payer: AZCH Complete Medicare |
$13.05
|
| Rate for Payer: Banner UC Health Medicaid |
$16.07
|
| Rate for Payer: Banner UC Health Medicare |
$13.05
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$56.55
|
| Rate for Payer: Copperpoint Commercial |
$21.53
|
| Rate for Payer: Health Net of AZ Commercial |
$52.20
|
| Rate for Payer: Health Net of AZ Medicare |
$24.36
|
| Rate for Payer: Humana of AZ Medicare |
$13.05
|
| Rate for Payer: Mercy Care Medicaid |
$16.07
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
| Rate for Payer: TriWest Medicare |
$13.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.66
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Aetna of AZ Medicare |
$24.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.49
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$13.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$13.05
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Copperpoint Commercial |
$21.53
|
| Rate for Payer: Health Net of AZ Commercial |
$52.20
|
| Rate for Payer: Health Net of AZ Medicare |
$24.36
|
| Rate for Payer: Humana of AZ Medicare |
$13.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
| Rate for Payer: TriWest Medicare |
$13.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.66
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Bisbee Police All Plans |
$16.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Self Pay Self Pay |
$50.40
|
|
|
SHOE POST-OP FEMALE MEDIUM
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna of AZ Commercial |
$56.70
|
| Rate for Payer: Aetna of AZ Medicare |
$17.64
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$9.45
|
| Rate for Payer: Amerigroup Medicare |
$9.45
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.53
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$9.45
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$9.45
|
| Rate for Payer: Bisbee Police All Plans |
$16.38
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$42.84
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of AZ Commercial |
$44.10
|
| Rate for Payer: Copperpoint Commercial |
$15.59
|
| Rate for Payer: Health Net of AZ Commercial |
$37.80
|
| Rate for Payer: Health Net of AZ Medicare |
$17.64
|
| Rate for Payer: Humana of AZ Medicare |
$9.45
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$50.40
|
| Rate for Payer: TriWest Medicare |
$9.45
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$36.73
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.34
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Aetna of AZ Medicare |
$24.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.49
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$13.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$13.05
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Copperpoint Commercial |
$21.53
|
| Rate for Payer: Health Net of AZ Commercial |
$52.20
|
| Rate for Payer: Health Net of AZ Medicare |
$24.36
|
| Rate for Payer: Humana of AZ Medicare |
$13.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
| Rate for Payer: TriWest Medicare |
$13.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.66
|
|
|
SHOE POST-OP FEMALE SMALL
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Aetna of AZ Medicare |
$24.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.49
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$13.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$13.05
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Copperpoint Commercial |
$21.53
|
| Rate for Payer: Health Net of AZ Commercial |
$52.20
|
| Rate for Payer: Health Net of AZ Medicare |
$24.36
|
| Rate for Payer: Humana of AZ Medicare |
$13.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
| Rate for Payer: TriWest Medicare |
$13.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.66
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna of AZ Commercial |
$78.30
|
| Rate for Payer: Aetna of AZ Medicare |
$24.36
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$13.05
|
| Rate for Payer: Amerigroup Medicare |
$13.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$32.49
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$13.05
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$13.05
|
| Rate for Payer: Bisbee Police All Plans |
$22.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$59.16
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna of AZ Commercial |
$60.90
|
| Rate for Payer: Copperpoint Commercial |
$21.53
|
| Rate for Payer: Health Net of AZ Commercial |
$52.20
|
| Rate for Payer: Health Net of AZ Medicare |
$24.36
|
| Rate for Payer: Humana of AZ Medicare |
$13.05
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$69.60
|
| Rate for Payer: TriWest Medicare |
$13.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$50.72
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$15.66
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Aetna of AZ Medicare |
$9.24
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.33
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$4.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$4.95
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Copperpoint Commercial |
$8.17
|
| Rate for Payer: Health Net of AZ Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9.24
|
| Rate for Payer: Humana of AZ Medicare |
$4.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
| Rate for Payer: TriWest Medicare |
$4.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.94
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Aetna of AZ Medicare |
$9.24
|
| Rate for Payer: AHCCCS Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicaid |
$0.13
|
| Rate for Payer: Allwell Medicare |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.33
|
| Rate for Payer: AZCH Complete Medicaid |
$0.13
|
| Rate for Payer: AZCH Complete Medicare |
$4.95
|
| Rate for Payer: Banner UC Health Medicaid |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$4.95
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Copperpoint Commercial |
$8.17
|
| Rate for Payer: Health Net of AZ Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9.24
|
| Rate for Payer: Humana of AZ Medicare |
$4.95
|
| Rate for Payer: Mercy Care Medicaid |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
| Rate for Payer: TriWest Medicare |
$4.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.94
|
|
|
SHOE POST-OP MALE X-SMALL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
22354306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
|
|
SHOE POST OP XL
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
|
|
SHOE POST OP XL
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
24045512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of AZ Commercial |
$29.70
|
| Rate for Payer: Aetna of AZ Medicare |
$9.24
|
| Rate for Payer: Allwell Medicare |
$4.95
|
| Rate for Payer: Amerigroup Medicare |
$4.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$12.33
|
| Rate for Payer: AZCH Complete Medicare |
$4.95
|
| Rate for Payer: Banner UC Health Medicare |
$4.95
|
| Rate for Payer: Bisbee Police All Plans |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$22.44
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of AZ Commercial |
$23.10
|
| Rate for Payer: Copperpoint Commercial |
$8.17
|
| Rate for Payer: Health Net of AZ Commercial |
$19.80
|
| Rate for Payer: Health Net of AZ Medicare |
$9.24
|
| Rate for Payer: Humana of AZ Medicare |
$4.95
|
| Rate for Payer: Self Pay Self Pay |
$26.40
|
| Rate for Payer: TriWest Medicare |
$4.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$19.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.94
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: AHCCCS Medicaid |
$15,847.43
|
| Rate for Payer: Allwell Medicaid |
$15,847.43
|
| Rate for Payer: AZCH Complete Medicaid |
$15,847.43
|
| Rate for Payer: Banner UC Health Medicaid |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3221
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: AHCCCS Medicaid |
$10,051.76
|
| Rate for Payer: Allwell Medicaid |
$10,051.76
|
| Rate for Payer: AZCH Complete Medicaid |
$10,051.76
|
| Rate for Payer: Banner UC Health Medicaid |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3222
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: AHCCCS Medicaid |
$15,847.43
|
| Rate for Payer: Allwell Medicaid |
$15,847.43
|
| Rate for Payer: AZCH Complete Medicaid |
$15,847.43
|
| Rate for Payer: Banner UC Health Medicaid |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$11,399.15
|
|
|
Service Code
|
APR-DRG 3222
|
| Hospital Charge Code |
APRDRG3222
|
| Min. Negotiated Rate |
$11,399.15 |
| Max. Negotiated Rate |
$11,399.15 |
| Rate for Payer: AHCCCS Medicaid |
$11,399.15
|
| Rate for Payer: Allwell Medicaid |
$11,399.15
|
| Rate for Payer: AZCH Complete Medicaid |
$11,399.15
|
| Rate for Payer: Banner UC Health Medicaid |
$11,399.15
|
| Rate for Payer: Mercy Care Medicaid |
$11,399.15
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$26,533.26
|
|
|
Service Code
|
APR-DRG 3224
|
| Hospital Charge Code |
APRDRG3224
|
| Min. Negotiated Rate |
$26,533.26 |
| Max. Negotiated Rate |
$26,533.26 |
| Rate for Payer: AHCCCS Medicaid |
$26,533.26
|
| Rate for Payer: Allwell Medicaid |
$26,533.26
|
| Rate for Payer: AZCH Complete Medicaid |
$26,533.26
|
| Rate for Payer: Banner UC Health Medicaid |
$26,533.26
|
| Rate for Payer: Mercy Care Medicaid |
$26,533.26
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$10,051.76
|
|
|
Service Code
|
APR-DRG 3221
|
| Hospital Charge Code |
APRDRG3223
|
| Min. Negotiated Rate |
$10,051.76 |
| Max. Negotiated Rate |
$10,051.76 |
| Rate for Payer: AHCCCS Medicaid |
$10,051.76
|
| Rate for Payer: Allwell Medicaid |
$10,051.76
|
| Rate for Payer: AZCH Complete Medicaid |
$10,051.76
|
| Rate for Payer: Banner UC Health Medicaid |
$10,051.76
|
| Rate for Payer: Mercy Care Medicaid |
$10,051.76
|
|
|
Shoulder And Elbow Joint Replacement
|
Facility
|
IP
|
$15,847.43
|
|
|
Service Code
|
APR-DRG 3223
|
| Hospital Charge Code |
APRDRG3224
|
| Min. Negotiated Rate |
$15,847.43 |
| Max. Negotiated Rate |
$15,847.43 |
| Rate for Payer: AHCCCS Medicaid |
$15,847.43
|
| Rate for Payer: Allwell Medicaid |
$15,847.43
|
| Rate for Payer: AZCH Complete Medicaid |
$15,847.43
|
| Rate for Payer: Banner UC Health Medicaid |
$15,847.43
|
| Rate for Payer: Mercy Care Medicaid |
$15,847.43
|
|
