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Charge Type Setting Price  
Service Code CPT 81401
Hospital Charge Code 22348727
Hospital Revenue Code 301
Min. Negotiated Rate $464.88
Max. Negotiated Rate $1,609.20
Rate for Payer: Aetna of AZ Commercial $1,609.20
Rate for Payer: Bisbee Police All Plans $464.88
Rate for Payer: Cash Price $1,430.40
Rate for Payer: Self Pay Self Pay $1,430.40
Service Code APR-DRG 0043
Hospital Charge Code APRDRG0042
Min. Negotiated Rate $74,757.32
Max. Negotiated Rate $74,757.32
Rate for Payer: AHCCCS Medicaid $74,757.32
Rate for Payer: Allwell Medicaid $74,757.32
Rate for Payer: AZCH Complete Medicaid $74,757.32
Rate for Payer: Banner UC Health Medicaid $74,757.32
Rate for Payer: Mercy Care Medicaid $74,757.32
Service Code APR-DRG 0043
Hospital Charge Code APRDRG0041
Min. Negotiated Rate $74,757.32
Max. Negotiated Rate $74,757.32
Rate for Payer: AHCCCS Medicaid $74,757.32
Rate for Payer: Allwell Medicaid $74,757.32
Rate for Payer: AZCH Complete Medicaid $74,757.32
Rate for Payer: Banner UC Health Medicaid $74,757.32
Rate for Payer: Mercy Care Medicaid $74,757.32
Service Code APR-DRG 0041
Hospital Charge Code APRDRG0044
Min. Negotiated Rate $44,109.64
Max. Negotiated Rate $44,109.64
Rate for Payer: AHCCCS Medicaid $44,109.64
Rate for Payer: Allwell Medicaid $44,109.64
Rate for Payer: AZCH Complete Medicaid $44,109.64
Rate for Payer: Banner UC Health Medicaid $44,109.64
Rate for Payer: Mercy Care Medicaid $44,109.64
Service Code APR-DRG 0042
Hospital Charge Code APRDRG0042
Min. Negotiated Rate $52,364.42
Max. Negotiated Rate $52,364.42
Rate for Payer: AHCCCS Medicaid $52,364.42
Rate for Payer: Allwell Medicaid $52,364.42
Rate for Payer: AZCH Complete Medicaid $52,364.42
Rate for Payer: Banner UC Health Medicaid $52,364.42
Rate for Payer: Mercy Care Medicaid $52,364.42
Service Code APR-DRG 0044
Hospital Charge Code APRDRG0044
Min. Negotiated Rate $109,327.92
Max. Negotiated Rate $109,327.92
Rate for Payer: AHCCCS Medicaid $109,327.92
Rate for Payer: Allwell Medicaid $109,327.92
Rate for Payer: AZCH Complete Medicaid $109,327.92
Rate for Payer: Banner UC Health Medicaid $109,327.92
Rate for Payer: Mercy Care Medicaid $109,327.92
Service Code APR-DRG 0044
Hospital Charge Code APRDRG0042
Min. Negotiated Rate $109,327.92
Max. Negotiated Rate $109,327.92
Rate for Payer: AHCCCS Medicaid $109,327.92
Rate for Payer: Allwell Medicaid $109,327.92
Rate for Payer: AZCH Complete Medicaid $109,327.92
Rate for Payer: Banner UC Health Medicaid $109,327.92
Rate for Payer: Mercy Care Medicaid $109,327.92
Service Code APR-DRG 0043
Hospital Charge Code APRDRG0043
Min. Negotiated Rate $74,757.32
Max. Negotiated Rate $74,757.32
Rate for Payer: AHCCCS Medicaid $74,757.32
Rate for Payer: Allwell Medicaid $74,757.32
Rate for Payer: AZCH Complete Medicaid $74,757.32
Rate for Payer: Banner UC Health Medicaid $74,757.32
Rate for Payer: Mercy Care Medicaid $74,757.32
Service Code APR-DRG 0041
Hospital Charge Code APRDRG0041
Min. Negotiated Rate $44,109.64
Max. Negotiated Rate $44,109.64
Rate for Payer: AHCCCS Medicaid $44,109.64
Rate for Payer: Allwell Medicaid $44,109.64
Rate for Payer: AZCH Complete Medicaid $44,109.64
Rate for Payer: Banner UC Health Medicaid $44,109.64
Rate for Payer: Mercy Care Medicaid $44,109.64
Service Code APR-DRG 0044
Hospital Charge Code APRDRG0041
Min. Negotiated Rate $109,327.92
Max. Negotiated Rate $109,327.92
Rate for Payer: AHCCCS Medicaid $109,327.92
Rate for Payer: Allwell Medicaid $109,327.92
Rate for Payer: AZCH Complete Medicaid $109,327.92
Rate for Payer: Banner UC Health Medicaid $109,327.92
Rate for Payer: Mercy Care Medicaid $109,327.92
Service Code APR-DRG 0041
Hospital Charge Code APRDRG0042
Min. Negotiated Rate $44,109.64
Max. Negotiated Rate $44,109.64
Rate for Payer: AHCCCS Medicaid $44,109.64
Rate for Payer: Allwell Medicaid $44,109.64
Rate for Payer: AZCH Complete Medicaid $44,109.64
Rate for Payer: Banner UC Health Medicaid $44,109.64
Rate for Payer: Mercy Care Medicaid $44,109.64
Service Code APR-DRG 0042
Hospital Charge Code APRDRG0041
Min. Negotiated Rate $52,364.42
Max. Negotiated Rate $52,364.42
Rate for Payer: AHCCCS Medicaid $52,364.42
Rate for Payer: Allwell Medicaid $52,364.42
Rate for Payer: AZCH Complete Medicaid $52,364.42
Rate for Payer: Banner UC Health Medicaid $52,364.42
Rate for Payer: Mercy Care Medicaid $52,364.42
Service Code APR-DRG 0041
Hospital Charge Code APRDRG0043
Min. Negotiated Rate $44,109.64
Max. Negotiated Rate $44,109.64
Rate for Payer: AHCCCS Medicaid $44,109.64
Rate for Payer: Allwell Medicaid $44,109.64
Rate for Payer: AZCH Complete Medicaid $44,109.64
Rate for Payer: Banner UC Health Medicaid $44,109.64
Rate for Payer: Mercy Care Medicaid $44,109.64
Service Code APR-DRG 0044
Hospital Charge Code APRDRG0043
Min. Negotiated Rate $109,327.92
Max. Negotiated Rate $109,327.92
Rate for Payer: AHCCCS Medicaid $109,327.92
Rate for Payer: Allwell Medicaid $109,327.92
Rate for Payer: AZCH Complete Medicaid $109,327.92
Rate for Payer: Banner UC Health Medicaid $109,327.92
Rate for Payer: Mercy Care Medicaid $109,327.92
Service Code APR-DRG 0042
Hospital Charge Code APRDRG0044
Min. Negotiated Rate $52,364.42
Max. Negotiated Rate $52,364.42
Rate for Payer: AHCCCS Medicaid $52,364.42
Rate for Payer: Allwell Medicaid $52,364.42
Rate for Payer: AZCH Complete Medicaid $52,364.42
Rate for Payer: Banner UC Health Medicaid $52,364.42
Rate for Payer: Mercy Care Medicaid $52,364.42
Service Code APR-DRG 0043
Hospital Charge Code APRDRG0044
Min. Negotiated Rate $74,757.32
Max. Negotiated Rate $74,757.32
Rate for Payer: AHCCCS Medicaid $74,757.32
Rate for Payer: Allwell Medicaid $74,757.32
Rate for Payer: AZCH Complete Medicaid $74,757.32
Rate for Payer: Banner UC Health Medicaid $74,757.32
Rate for Payer: Mercy Care Medicaid $74,757.32
Service Code APR-DRG 0042
Hospital Charge Code APRDRG0043
Min. Negotiated Rate $52,364.42
Max. Negotiated Rate $52,364.42
Rate for Payer: AHCCCS Medicaid $52,364.42
Rate for Payer: Allwell Medicaid $52,364.42
Rate for Payer: AZCH Complete Medicaid $52,364.42
Rate for Payer: Banner UC Health Medicaid $52,364.42
Rate for Payer: Mercy Care Medicaid $52,364.42
Service Code APR-DRG 0054
Hospital Charge Code APRDRG0053
Min. Negotiated Rate $71,753.92
Max. Negotiated Rate $71,753.92
Rate for Payer: AHCCCS Medicaid $71,753.92
Rate for Payer: Allwell Medicaid $71,753.92
Rate for Payer: AZCH Complete Medicaid $71,753.92
Rate for Payer: Banner UC Health Medicaid $71,753.92
Rate for Payer: Mercy Care Medicaid $71,753.92
Service Code APR-DRG 0053
Hospital Charge Code APRDRG0053
Min. Negotiated Rate $50,436.27
Max. Negotiated Rate $50,436.27
Rate for Payer: AHCCCS Medicaid $50,436.27
Rate for Payer: Allwell Medicaid $50,436.27
Rate for Payer: AZCH Complete Medicaid $50,436.27
Rate for Payer: Banner UC Health Medicaid $50,436.27
Rate for Payer: Mercy Care Medicaid $50,436.27
Service Code APR-DRG 0053
Hospital Charge Code APRDRG0052
Min. Negotiated Rate $50,436.27
Max. Negotiated Rate $50,436.27
Rate for Payer: AHCCCS Medicaid $50,436.27
Rate for Payer: Allwell Medicaid $50,436.27
Rate for Payer: AZCH Complete Medicaid $50,436.27
Rate for Payer: Banner UC Health Medicaid $50,436.27
Rate for Payer: Mercy Care Medicaid $50,436.27
Service Code APR-DRG 0051
Hospital Charge Code APRDRG0053
Min. Negotiated Rate $29,144.57
Max. Negotiated Rate $29,144.57
Rate for Payer: AHCCCS Medicaid $29,144.57
Rate for Payer: Allwell Medicaid $29,144.57
Rate for Payer: AZCH Complete Medicaid $29,144.57
Rate for Payer: Banner UC Health Medicaid $29,144.57
Rate for Payer: Mercy Care Medicaid $29,144.57
Service Code APR-DRG 0054
Hospital Charge Code APRDRG0054
Min. Negotiated Rate $71,753.92
Max. Negotiated Rate $71,753.92
Rate for Payer: AHCCCS Medicaid $71,753.92
Rate for Payer: Allwell Medicaid $71,753.92
Rate for Payer: AZCH Complete Medicaid $71,753.92
Rate for Payer: Banner UC Health Medicaid $71,753.92
Rate for Payer: Mercy Care Medicaid $71,753.92
Service Code APR-DRG 0052
Hospital Charge Code APRDRG0051
Min. Negotiated Rate $39,671.18
Max. Negotiated Rate $39,671.18
Rate for Payer: AHCCCS Medicaid $39,671.18
Rate for Payer: Allwell Medicaid $39,671.18
Rate for Payer: AZCH Complete Medicaid $39,671.18
Rate for Payer: Banner UC Health Medicaid $39,671.18
Rate for Payer: Mercy Care Medicaid $39,671.18
Service Code APR-DRG 0053
Hospital Charge Code APRDRG0054
Min. Negotiated Rate $50,436.27
Max. Negotiated Rate $50,436.27
Rate for Payer: AHCCCS Medicaid $50,436.27
Rate for Payer: Allwell Medicaid $50,436.27
Rate for Payer: AZCH Complete Medicaid $50,436.27
Rate for Payer: Banner UC Health Medicaid $50,436.27
Rate for Payer: Mercy Care Medicaid $50,436.27
Service Code APR-DRG 0052
Hospital Charge Code APRDRG0053
Min. Negotiated Rate $39,671.18
Max. Negotiated Rate $39,671.18
Rate for Payer: AHCCCS Medicaid $39,671.18
Rate for Payer: Allwell Medicaid $39,671.18
Rate for Payer: AZCH Complete Medicaid $39,671.18
Rate for Payer: Banner UC Health Medicaid $39,671.18
Rate for Payer: Mercy Care Medicaid $39,671.18