Speed Band Superview Super 7
|
Facility
|
IP
|
$1,222.00
|
|
Hospital Charge Code |
22926474
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$317.72 |
Max. Negotiated Rate |
$1,099.80 |
Rate for Payer: Aetna of AZ Commercial |
$1,099.80
|
Rate for Payer: Bisbee Police All Plans |
$317.72
|
Rate for Payer: Cash Price |
$977.60
|
Rate for Payer: Self Pay Self Pay |
$977.60
|
|
Speed Band Superview Super 7
|
Facility
|
OP
|
$1,222.00
|
|
Hospital Charge Code |
22926474
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$183.30 |
Max. Negotiated Rate |
$1,099.80 |
Rate for Payer: Aetna of AZ Commercial |
$1,099.80
|
Rate for Payer: Aetna of AZ Medicare |
$342.16
|
Rate for Payer: Allwell Medicare |
$183.30
|
Rate for Payer: Amerigroup Medicare |
$183.30
|
Rate for Payer: APIPA Medicare/Medicaid |
$456.42
|
Rate for Payer: AZCH Complete Medicare |
$183.30
|
Rate for Payer: Banner UC Health Medicare |
$183.30
|
Rate for Payer: Bisbee Police All Plans |
$317.72
|
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$830.96
|
Rate for Payer: Cash Price |
$977.60
|
Rate for Payer: Cigna of AZ Commercial |
$855.40
|
Rate for Payer: Copperpoint Commercial |
$302.44
|
Rate for Payer: Health Net of AZ Commercial |
$733.20
|
Rate for Payer: Health Net of AZ Medicare |
$342.16
|
Rate for Payer: Humana of AZ Medicare |
$183.30
|
Rate for Payer: Self Pay Self Pay |
$977.60
|
Rate for Payer: TriWest Medicare |
$183.30
|
Rate for Payer: UnitedHealth Group of AZ Commercial |
$712.43
|
Rate for Payer: UnitedHealth Group of AZ Medicare |
$219.96
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$13,968.38
|
|
Service Code
|
APR-DRG 0403
|
Hospital Charge Code |
APRDRG0404
|
Min. Negotiated Rate |
$13,968.38 |
Max. Negotiated Rate |
$13,968.38 |
Rate for Payer: AHCCCS Medicaid |
$13,968.38
|
Rate for Payer: Allwell Medicaid |
$13,968.38
|
Rate for Payer: AZCH Complete Medicaid |
$13,968.38
|
Rate for Payer: Banner UC Health Medicaid |
$13,968.38
|
Rate for Payer: Mercy Care Medicaid |
$13,968.38
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$13,968.38
|
|
Service Code
|
APR-DRG 0403
|
Hospital Charge Code |
APRDRG0401
|
Min. Negotiated Rate |
$13,968.38 |
Max. Negotiated Rate |
$13,968.38 |
Rate for Payer: AHCCCS Medicaid |
$13,968.38
|
Rate for Payer: Allwell Medicaid |
$13,968.38
|
Rate for Payer: AZCH Complete Medicaid |
$13,968.38
|
Rate for Payer: Banner UC Health Medicaid |
$13,968.38
|
Rate for Payer: Mercy Care Medicaid |
$13,968.38
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$9,300.56
|
|
Service Code
|
APR-DRG 0402
|
Hospital Charge Code |
APRDRG0404
|
Min. Negotiated Rate |
$9,300.56 |
Max. Negotiated Rate |
$9,300.56 |
Rate for Payer: AHCCCS Medicaid |
$9,300.56
|
Rate for Payer: Allwell Medicaid |
$9,300.56
|
Rate for Payer: AZCH Complete Medicaid |
$9,300.56
|
Rate for Payer: Banner UC Health Medicaid |
$9,300.56
|
Rate for Payer: Mercy Care Medicaid |
$9,300.56
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$23,362.23
|
|
Service Code
|
APR-DRG 0404
|
Hospital Charge Code |
APRDRG0401
|
Min. Negotiated Rate |
$23,362.23 |
Max. Negotiated Rate |
$23,362.23 |
Rate for Payer: AHCCCS Medicaid |
$23,362.23
|
Rate for Payer: Allwell Medicaid |
$23,362.23
|
Rate for Payer: AZCH Complete Medicaid |
$23,362.23
|
Rate for Payer: Banner UC Health Medicaid |
$23,362.23
|
Rate for Payer: Mercy Care Medicaid |
$23,362.23
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$23,362.23
|
|
Service Code
|
APR-DRG 0404
|
Hospital Charge Code |
APRDRG0402
|
Min. Negotiated Rate |
$23,362.23 |
Max. Negotiated Rate |
$23,362.23 |
Rate for Payer: AHCCCS Medicaid |
$23,362.23
|
Rate for Payer: Allwell Medicaid |
$23,362.23
|
Rate for Payer: AZCH Complete Medicaid |
$23,362.23
|
Rate for Payer: Banner UC Health Medicaid |
$23,362.23
|
Rate for Payer: Mercy Care Medicaid |
$23,362.23
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$23,362.23
|
|
Service Code
|
APR-DRG 0404
|
Hospital Charge Code |
APRDRG0403
|
Min. Negotiated Rate |
$23,362.23 |
Max. Negotiated Rate |
$23,362.23 |
Rate for Payer: AHCCCS Medicaid |
$23,362.23
|
Rate for Payer: Allwell Medicaid |
$23,362.23
|
Rate for Payer: AZCH Complete Medicaid |
$23,362.23
|
Rate for Payer: Banner UC Health Medicaid |
$23,362.23
|
Rate for Payer: Mercy Care Medicaid |
$23,362.23
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$6,868.11
|
|
Service Code
|
APR-DRG 0401
|
Hospital Charge Code |
APRDRG0401
|
Min. Negotiated Rate |
$6,868.11 |
Max. Negotiated Rate |
$6,868.11 |
Rate for Payer: AHCCCS Medicaid |
$6,868.11
|
Rate for Payer: Allwell Medicaid |
$6,868.11
|
Rate for Payer: AZCH Complete Medicaid |
$6,868.11
|
Rate for Payer: Banner UC Health Medicaid |
$6,868.11
|
Rate for Payer: Mercy Care Medicaid |
$6,868.11
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$6,868.11
|
|
Service Code
|
APR-DRG 0401
|
Hospital Charge Code |
APRDRG0403
|
Min. Negotiated Rate |
$6,868.11 |
Max. Negotiated Rate |
$6,868.11 |
Rate for Payer: AHCCCS Medicaid |
$6,868.11
|
Rate for Payer: Allwell Medicaid |
$6,868.11
|
Rate for Payer: AZCH Complete Medicaid |
$6,868.11
|
Rate for Payer: Banner UC Health Medicaid |
$6,868.11
|
Rate for Payer: Mercy Care Medicaid |
$6,868.11
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$13,968.38
|
|
Service Code
|
APR-DRG 0403
|
Hospital Charge Code |
APRDRG0403
|
Min. Negotiated Rate |
$13,968.38 |
Max. Negotiated Rate |
$13,968.38 |
Rate for Payer: AHCCCS Medicaid |
$13,968.38
|
Rate for Payer: Allwell Medicaid |
$13,968.38
|
Rate for Payer: AZCH Complete Medicaid |
$13,968.38
|
Rate for Payer: Banner UC Health Medicaid |
$13,968.38
|
Rate for Payer: Mercy Care Medicaid |
$13,968.38
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$9,300.56
|
|
Service Code
|
APR-DRG 0402
|
Hospital Charge Code |
APRDRG0401
|
Min. Negotiated Rate |
$9,300.56 |
Max. Negotiated Rate |
$9,300.56 |
Rate for Payer: AHCCCS Medicaid |
$9,300.56
|
Rate for Payer: Allwell Medicaid |
$9,300.56
|
Rate for Payer: AZCH Complete Medicaid |
$9,300.56
|
Rate for Payer: Banner UC Health Medicaid |
$9,300.56
|
Rate for Payer: Mercy Care Medicaid |
$9,300.56
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$6,868.11
|
|
Service Code
|
APR-DRG 0401
|
Hospital Charge Code |
APRDRG0402
|
Min. Negotiated Rate |
$6,868.11 |
Max. Negotiated Rate |
$6,868.11 |
Rate for Payer: AHCCCS Medicaid |
$6,868.11
|
Rate for Payer: Allwell Medicaid |
$6,868.11
|
Rate for Payer: AZCH Complete Medicaid |
$6,868.11
|
Rate for Payer: Banner UC Health Medicaid |
$6,868.11
|
Rate for Payer: Mercy Care Medicaid |
$6,868.11
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$9,300.56
|
|
Service Code
|
APR-DRG 0402
|
Hospital Charge Code |
APRDRG0402
|
Min. Negotiated Rate |
$9,300.56 |
Max. Negotiated Rate |
$9,300.56 |
Rate for Payer: AHCCCS Medicaid |
$9,300.56
|
Rate for Payer: Allwell Medicaid |
$9,300.56
|
Rate for Payer: AZCH Complete Medicaid |
$9,300.56
|
Rate for Payer: Banner UC Health Medicaid |
$9,300.56
|
Rate for Payer: Mercy Care Medicaid |
$9,300.56
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$9,300.56
|
|
Service Code
|
APR-DRG 0402
|
Hospital Charge Code |
APRDRG0403
|
Min. Negotiated Rate |
$9,300.56 |
Max. Negotiated Rate |
$9,300.56 |
Rate for Payer: AHCCCS Medicaid |
$9,300.56
|
Rate for Payer: Allwell Medicaid |
$9,300.56
|
Rate for Payer: AZCH Complete Medicaid |
$9,300.56
|
Rate for Payer: Banner UC Health Medicaid |
$9,300.56
|
Rate for Payer: Mercy Care Medicaid |
$9,300.56
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$6,868.11
|
|
Service Code
|
APR-DRG 0401
|
Hospital Charge Code |
APRDRG0404
|
Min. Negotiated Rate |
$6,868.11 |
Max. Negotiated Rate |
$6,868.11 |
Rate for Payer: AHCCCS Medicaid |
$6,868.11
|
Rate for Payer: Allwell Medicaid |
$6,868.11
|
Rate for Payer: AZCH Complete Medicaid |
$6,868.11
|
Rate for Payer: Banner UC Health Medicaid |
$6,868.11
|
Rate for Payer: Mercy Care Medicaid |
$6,868.11
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$23,362.23
|
|
Service Code
|
APR-DRG 0404
|
Hospital Charge Code |
APRDRG0404
|
Min. Negotiated Rate |
$23,362.23 |
Max. Negotiated Rate |
$23,362.23 |
Rate for Payer: AHCCCS Medicaid |
$23,362.23
|
Rate for Payer: Allwell Medicaid |
$23,362.23
|
Rate for Payer: AZCH Complete Medicaid |
$23,362.23
|
Rate for Payer: Banner UC Health Medicaid |
$23,362.23
|
Rate for Payer: Mercy Care Medicaid |
$23,362.23
|
|
Spinal Disorders And Injuries
|
Facility
|
IP
|
$13,968.38
|
|
Service Code
|
APR-DRG 0403
|
Hospital Charge Code |
APRDRG0402
|
Min. Negotiated Rate |
$13,968.38 |
Max. Negotiated Rate |
$13,968.38 |
Rate for Payer: AHCCCS Medicaid |
$13,968.38
|
Rate for Payer: Allwell Medicaid |
$13,968.38
|
Rate for Payer: AZCH Complete Medicaid |
$13,968.38
|
Rate for Payer: Banner UC Health Medicaid |
$13,968.38
|
Rate for Payer: Mercy Care Medicaid |
$13,968.38
|
|
Spinal Procedures
|
Facility
|
IP
|
$25,776.45
|
|
Service Code
|
APR-DRG 0233
|
Hospital Charge Code |
APRDRG0232
|
Min. Negotiated Rate |
$25,776.45 |
Max. Negotiated Rate |
$25,776.45 |
Rate for Payer: AHCCCS Medicaid |
$25,776.45
|
Rate for Payer: Allwell Medicaid |
$25,776.45
|
Rate for Payer: AZCH Complete Medicaid |
$25,776.45
|
Rate for Payer: Banner UC Health Medicaid |
$25,776.45
|
Rate for Payer: Mercy Care Medicaid |
$25,776.45
|
|
Spinal Procedures
|
Facility
|
IP
|
$14,480.40
|
|
Service Code
|
APR-DRG 0232
|
Hospital Charge Code |
APRDRG0233
|
Min. Negotiated Rate |
$14,480.40 |
Max. Negotiated Rate |
$14,480.40 |
Rate for Payer: AHCCCS Medicaid |
$14,480.40
|
Rate for Payer: Allwell Medicaid |
$14,480.40
|
Rate for Payer: AZCH Complete Medicaid |
$14,480.40
|
Rate for Payer: Banner UC Health Medicaid |
$14,480.40
|
Rate for Payer: Mercy Care Medicaid |
$14,480.40
|
|
Spinal Procedures
|
Facility
|
IP
|
$25,776.45
|
|
Service Code
|
APR-DRG 0233
|
Hospital Charge Code |
APRDRG0234
|
Min. Negotiated Rate |
$25,776.45 |
Max. Negotiated Rate |
$25,776.45 |
Rate for Payer: AHCCCS Medicaid |
$25,776.45
|
Rate for Payer: Allwell Medicaid |
$25,776.45
|
Rate for Payer: AZCH Complete Medicaid |
$25,776.45
|
Rate for Payer: Banner UC Health Medicaid |
$25,776.45
|
Rate for Payer: Mercy Care Medicaid |
$25,776.45
|
|
Spinal Procedures
|
Facility
|
IP
|
$10,554.67
|
|
Service Code
|
APR-DRG 0231
|
Hospital Charge Code |
APRDRG0234
|
Min. Negotiated Rate |
$10,554.67 |
Max. Negotiated Rate |
$10,554.67 |
Rate for Payer: AHCCCS Medicaid |
$10,554.67
|
Rate for Payer: Allwell Medicaid |
$10,554.67
|
Rate for Payer: AZCH Complete Medicaid |
$10,554.67
|
Rate for Payer: Banner UC Health Medicaid |
$10,554.67
|
Rate for Payer: Mercy Care Medicaid |
$10,554.67
|
|
Spinal Procedures
|
Facility
|
IP
|
$10,554.67
|
|
Service Code
|
APR-DRG 0231
|
Hospital Charge Code |
APRDRG0232
|
Min. Negotiated Rate |
$10,554.67 |
Max. Negotiated Rate |
$10,554.67 |
Rate for Payer: AHCCCS Medicaid |
$10,554.67
|
Rate for Payer: Allwell Medicaid |
$10,554.67
|
Rate for Payer: AZCH Complete Medicaid |
$10,554.67
|
Rate for Payer: Banner UC Health Medicaid |
$10,554.67
|
Rate for Payer: Mercy Care Medicaid |
$10,554.67
|
|
Spinal Procedures
|
Facility
|
IP
|
$40,597.73
|
|
Service Code
|
APR-DRG 0234
|
Hospital Charge Code |
APRDRG0233
|
Min. Negotiated Rate |
$40,597.73 |
Max. Negotiated Rate |
$40,597.73 |
Rate for Payer: AHCCCS Medicaid |
$40,597.73
|
Rate for Payer: Allwell Medicaid |
$40,597.73
|
Rate for Payer: AZCH Complete Medicaid |
$40,597.73
|
Rate for Payer: Banner UC Health Medicaid |
$40,597.73
|
Rate for Payer: Mercy Care Medicaid |
$40,597.73
|
|
Spinal Procedures
|
Facility
|
IP
|
$14,480.40
|
|
Service Code
|
APR-DRG 0232
|
Hospital Charge Code |
APRDRG0231
|
Min. Negotiated Rate |
$14,480.40 |
Max. Negotiated Rate |
$14,480.40 |
Rate for Payer: AHCCCS Medicaid |
$14,480.40
|
Rate for Payer: Allwell Medicaid |
$14,480.40
|
Rate for Payer: AZCH Complete Medicaid |
$14,480.40
|
Rate for Payer: Banner UC Health Medicaid |
$14,480.40
|
Rate for Payer: Mercy Care Medicaid |
$14,480.40
|
|