|
TEL 613-8S
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
22354822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.15 |
| Max. Negotiated Rate |
$774.90 |
| Rate for Payer: Aetna of AZ Commercial |
$774.90
|
| Rate for Payer: Aetna of AZ Medicare |
$241.08
|
| Rate for Payer: Allwell Medicare |
$129.15
|
| Rate for Payer: Amerigroup Medicare |
$129.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$321.58
|
| Rate for Payer: AZCH Complete Medicare |
$129.15
|
| Rate for Payer: Banner UC Health Medicare |
$129.15
|
| Rate for Payer: Bisbee Police All Plans |
$223.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$585.48
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna of AZ Commercial |
$602.70
|
| Rate for Payer: Copperpoint Commercial |
$213.10
|
| Rate for Payer: Health Net of AZ Commercial |
$516.60
|
| Rate for Payer: Health Net of AZ Medicare |
$241.08
|
| Rate for Payer: Humana of AZ Medicare |
$129.15
|
| Rate for Payer: Self Pay Self Pay |
$688.80
|
| Rate for Payer: TriWest Medicare |
$129.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$501.96
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$154.98
|
|
|
TELEHEALTH CARDIO SITE FACILITY FEE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247983
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Aetna of AZ Medicare |
$17.36
|
| Rate for Payer: Allwell Medicare |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.16
|
| Rate for Payer: AZCH Complete Medicare |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$9.30
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$42.16
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cigna of AZ Commercial |
$43.40
|
| Rate for Payer: Copperpoint Commercial |
$15.34
|
| Rate for Payer: Health Net of AZ Commercial |
$37.20
|
| Rate for Payer: Health Net of AZ Medicare |
$17.36
|
| Rate for Payer: Humana of AZ Medicare |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
| Rate for Payer: TriWest Medicare |
$9.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$36.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.16
|
|
|
TELEHEALTH CARDIO SITE FACILITY FEE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247983
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT G0427
|
| Hospital Charge Code |
24270136
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of AZ Commercial |
$820.80
|
| Rate for Payer: Bisbee Police All Plans |
$237.12
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Self Pay Self Pay |
$729.60
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT G0427
|
| Hospital Charge Code |
24270136
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna of AZ Commercial |
$820.80
|
| Rate for Payer: Aetna of AZ Medicare |
$255.36
|
| Rate for Payer: Allwell Medicare |
$136.80
|
| Rate for Payer: Amerigroup Medicare |
$136.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$340.63
|
| Rate for Payer: AZCH Complete Medicare |
$136.80
|
| Rate for Payer: Banner UC Health Medicare |
$136.80
|
| Rate for Payer: Bisbee Police All Plans |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$620.16
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna of AZ Commercial |
$638.40
|
| Rate for Payer: Copperpoint Commercial |
$225.72
|
| Rate for Payer: Health Net of AZ Commercial |
$547.20
|
| Rate for Payer: Health Net of AZ Medicare |
$255.36
|
| Rate for Payer: Humana of AZ Medicare |
$136.80
|
| Rate for Payer: Self Pay Self Pay |
$729.60
|
| Rate for Payer: TriWest Medicare |
$136.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$531.70
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$164.16
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT G0425
|
| Hospital Charge Code |
24270131
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Aetna of AZ Commercial |
$425.70
|
| Rate for Payer: Aetna of AZ Medicare |
$132.44
|
| Rate for Payer: Allwell Medicare |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$70.95
|
| Rate for Payer: APIPA Medicare/Medicaid |
$176.67
|
| Rate for Payer: AZCH Complete Medicare |
$70.95
|
| Rate for Payer: Banner UC Health Medicare |
$70.95
|
| Rate for Payer: Bisbee Police All Plans |
$122.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$321.64
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cigna of AZ Commercial |
$331.10
|
| Rate for Payer: Copperpoint Commercial |
$117.07
|
| Rate for Payer: Health Net of AZ Commercial |
$283.80
|
| Rate for Payer: Health Net of AZ Medicare |
$132.44
|
| Rate for Payer: Humana of AZ Medicare |
$70.95
|
| Rate for Payer: Self Pay Self Pay |
$378.40
|
| Rate for Payer: TriWest Medicare |
$70.95
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$275.76
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$85.14
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT G0426
|
| Hospital Charge Code |
24270135
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Aetna of AZ Commercial |
$577.80
|
| Rate for Payer: Aetna of AZ Medicare |
$179.76
|
| Rate for Payer: Allwell Medicare |
$96.30
|
| Rate for Payer: Amerigroup Medicare |
$96.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$239.79
|
| Rate for Payer: AZCH Complete Medicare |
$96.30
|
| Rate for Payer: Banner UC Health Medicare |
$96.30
|
| Rate for Payer: Bisbee Police All Plans |
$166.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$436.56
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna of AZ Commercial |
$449.40
|
| Rate for Payer: Copperpoint Commercial |
$158.90
|
| Rate for Payer: Health Net of AZ Commercial |
$385.20
|
| Rate for Payer: Health Net of AZ Medicare |
$179.76
|
| Rate for Payer: Humana of AZ Medicare |
$96.30
|
| Rate for Payer: Self Pay Self Pay |
$513.60
|
| Rate for Payer: TriWest Medicare |
$96.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$374.29
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$115.56
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT G0425
|
| Hospital Charge Code |
24270131
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Aetna of AZ Commercial |
$425.70
|
| Rate for Payer: Bisbee Police All Plans |
$122.98
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Self Pay Self Pay |
$378.40
|
|
|
TELEHEALTH CONSULTATION, EMERGENCY DEPT OR INPATIENT TYPICAL
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT G0426
|
| Hospital Charge Code |
24270135
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Aetna of AZ Commercial |
$577.80
|
| Rate for Payer: Bisbee Police All Plans |
$166.92
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Self Pay Self Pay |
$513.60
|
|
|
TELEHEALTH NEURO SITE FACILITY FEE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247982
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Aetna of AZ Medicare |
$17.36
|
| Rate for Payer: Allwell Medicare |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.16
|
| Rate for Payer: AZCH Complete Medicare |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$9.30
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$42.16
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cigna of AZ Commercial |
$43.40
|
| Rate for Payer: Copperpoint Commercial |
$15.34
|
| Rate for Payer: Health Net of AZ Commercial |
$37.20
|
| Rate for Payer: Health Net of AZ Medicare |
$17.36
|
| Rate for Payer: Humana of AZ Medicare |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
| Rate for Payer: TriWest Medicare |
$9.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$36.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.16
|
|
|
TELEHEALTH NEURO SITE FACILITY FEE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247982
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
|
|
TELEHEALTH PULMON SITE FACILITY FEE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247984
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Aetna of AZ Medicare |
$17.36
|
| Rate for Payer: Allwell Medicare |
$9.30
|
| Rate for Payer: Amerigroup Medicare |
$9.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$23.16
|
| Rate for Payer: AZCH Complete Medicare |
$9.30
|
| Rate for Payer: Banner UC Health Medicare |
$9.30
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$42.16
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cigna of AZ Commercial |
$43.40
|
| Rate for Payer: Copperpoint Commercial |
$15.34
|
| Rate for Payer: Health Net of AZ Commercial |
$37.20
|
| Rate for Payer: Health Net of AZ Medicare |
$17.36
|
| Rate for Payer: Humana of AZ Medicare |
$9.30
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
| Rate for Payer: TriWest Medicare |
$9.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$36.15
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$11.16
|
|
|
TELEHEALTH PULMON SITE FACILITY FEE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
22247984
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna of AZ Commercial |
$55.80
|
| Rate for Payer: Bisbee Police All Plans |
$16.12
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Self Pay Self Pay |
$49.60
|
|
|
temazepam 15 mg Cap [CQCH]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 67877014601
|
| Hospital Charge Code |
105943112
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
|
|
temazepam 15 mg Cap [CQCH]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 67877014601
|
| Hospital Charge Code |
105943112
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of AZ Commercial |
$0.07
|
| Rate for Payer: Aetna of AZ Medicare |
$0.02
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.03
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.05
|
| Rate for Payer: Copperpoint Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Commercial |
$0.05
|
| Rate for Payer: Health Net of AZ Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.05
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3174
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: AHCCCS Medicaid |
$6,375.02
|
| Rate for Payer: Allwell Medicaid |
$6,375.02
|
| Rate for Payer: AZCH Complete Medicaid |
$6,375.02
|
| Rate for Payer: Banner UC Health Medicaid |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$27,861.71
|
|
|
Service Code
|
APR-DRG 3174
|
| Hospital Charge Code |
APRDRG3174
|
| Min. Negotiated Rate |
$27,861.71 |
| Max. Negotiated Rate |
$27,861.71 |
| Rate for Payer: AHCCCS Medicaid |
$27,861.71
|
| Rate for Payer: Allwell Medicaid |
$27,861.71
|
| Rate for Payer: AZCH Complete Medicaid |
$27,861.71
|
| Rate for Payer: Banner UC Health Medicaid |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3173
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: AHCCCS Medicaid |
$6,375.02
|
| Rate for Payer: Allwell Medicaid |
$6,375.02
|
| Rate for Payer: AZCH Complete Medicaid |
$6,375.02
|
| Rate for Payer: Banner UC Health Medicaid |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3174
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: AHCCCS Medicaid |
$14,282.61
|
| Rate for Payer: Allwell Medicaid |
$14,282.61
|
| Rate for Payer: AZCH Complete Medicaid |
$14,282.61
|
| Rate for Payer: Banner UC Health Medicaid |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$8,805.38
|
|
|
Service Code
|
APR-DRG 3172
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$8,805.38 |
| Max. Negotiated Rate |
$8,805.38 |
| Rate for Payer: AHCCCS Medicaid |
$8,805.38
|
| Rate for Payer: Allwell Medicaid |
$8,805.38
|
| Rate for Payer: AZCH Complete Medicaid |
$8,805.38
|
| Rate for Payer: Banner UC Health Medicaid |
$8,805.38
|
| Rate for Payer: Mercy Care Medicaid |
$8,805.38
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$6,375.02
|
|
|
Service Code
|
APR-DRG 3171
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$6,375.02 |
| Max. Negotiated Rate |
$6,375.02 |
| Rate for Payer: AHCCCS Medicaid |
$6,375.02
|
| Rate for Payer: Allwell Medicaid |
$6,375.02
|
| Rate for Payer: AZCH Complete Medicaid |
$6,375.02
|
| Rate for Payer: Banner UC Health Medicaid |
$6,375.02
|
| Rate for Payer: Mercy Care Medicaid |
$6,375.02
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3171
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: AHCCCS Medicaid |
$14,282.61
|
| Rate for Payer: Allwell Medicaid |
$14,282.61
|
| Rate for Payer: AZCH Complete Medicaid |
$14,282.61
|
| Rate for Payer: Banner UC Health Medicaid |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$27,861.71
|
|
|
Service Code
|
APR-DRG 3174
|
| Hospital Charge Code |
APRDRG3173
|
| Min. Negotiated Rate |
$27,861.71 |
| Max. Negotiated Rate |
$27,861.71 |
| Rate for Payer: AHCCCS Medicaid |
$27,861.71
|
| Rate for Payer: Allwell Medicaid |
$27,861.71
|
| Rate for Payer: AZCH Complete Medicaid |
$27,861.71
|
| Rate for Payer: Banner UC Health Medicaid |
$27,861.71
|
| Rate for Payer: Mercy Care Medicaid |
$27,861.71
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$8,805.38
|
|
|
Service Code
|
APR-DRG 3172
|
| Hospital Charge Code |
APRDRG3174
|
| Min. Negotiated Rate |
$8,805.38 |
| Max. Negotiated Rate |
$8,805.38 |
| Rate for Payer: AHCCCS Medicaid |
$8,805.38
|
| Rate for Payer: Allwell Medicaid |
$8,805.38
|
| Rate for Payer: AZCH Complete Medicaid |
$8,805.38
|
| Rate for Payer: Banner UC Health Medicaid |
$8,805.38
|
| Rate for Payer: Mercy Care Medicaid |
$8,805.38
|
|
|
Tendon, Muscle And Other Soft Tissue Procedures
|
Facility
|
IP
|
$14,282.61
|
|
|
Service Code
|
APR-DRG 3173
|
| Hospital Charge Code |
APRDRG3172
|
| Min. Negotiated Rate |
$14,282.61 |
| Max. Negotiated Rate |
$14,282.61 |
| Rate for Payer: AHCCCS Medicaid |
$14,282.61
|
| Rate for Payer: Allwell Medicaid |
$14,282.61
|
| Rate for Payer: AZCH Complete Medicaid |
$14,282.61
|
| Rate for Payer: Banner UC Health Medicaid |
$14,282.61
|
| Rate for Payer: Mercy Care Medicaid |
$14,282.61
|
|
