|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$11,077.21
|
|
|
Service Code
|
APR-DRG 0222
|
| Hospital Charge Code |
APRDRG0224
|
| Min. Negotiated Rate |
$11,077.21 |
| Max. Negotiated Rate |
$11,077.21 |
| Rate for Payer: AHCCCS Medicaid |
$11,077.21
|
| Rate for Payer: Allwell Medicaid |
$11,077.21
|
| Rate for Payer: AZCH Complete Medicaid |
$11,077.21
|
| Rate for Payer: Banner UC Health Medicaid |
$11,077.21
|
| Rate for Payer: Mercy Care Medicaid |
$11,077.21
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$18,163.45
|
|
|
Service Code
|
APR-DRG 0223
|
| Hospital Charge Code |
APRDRG0223
|
| Min. Negotiated Rate |
$18,163.45 |
| Max. Negotiated Rate |
$18,163.45 |
| Rate for Payer: AHCCCS Medicaid |
$18,163.45
|
| Rate for Payer: Allwell Medicaid |
$18,163.45
|
| Rate for Payer: AZCH Complete Medicaid |
$18,163.45
|
| Rate for Payer: Banner UC Health Medicaid |
$18,163.45
|
| Rate for Payer: Mercy Care Medicaid |
$18,163.45
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$18,163.45
|
|
|
Service Code
|
APR-DRG 0223
|
| Hospital Charge Code |
APRDRG0221
|
| Min. Negotiated Rate |
$18,163.45 |
| Max. Negotiated Rate |
$18,163.45 |
| Rate for Payer: AHCCCS Medicaid |
$18,163.45
|
| Rate for Payer: Allwell Medicaid |
$18,163.45
|
| Rate for Payer: AZCH Complete Medicaid |
$18,163.45
|
| Rate for Payer: Banner UC Health Medicaid |
$18,163.45
|
| Rate for Payer: Mercy Care Medicaid |
$18,163.45
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$8,652.47
|
|
|
Service Code
|
APR-DRG 0221
|
| Hospital Charge Code |
APRDRG0223
|
| Min. Negotiated Rate |
$8,652.47 |
| Max. Negotiated Rate |
$8,652.47 |
| Rate for Payer: AHCCCS Medicaid |
$8,652.47
|
| Rate for Payer: Allwell Medicaid |
$8,652.47
|
| Rate for Payer: AZCH Complete Medicaid |
$8,652.47
|
| Rate for Payer: Banner UC Health Medicaid |
$8,652.47
|
| Rate for Payer: Mercy Care Medicaid |
$8,652.47
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0221
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0222
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$11,077.21
|
|
|
Service Code
|
APR-DRG 0222
|
| Hospital Charge Code |
APRDRG0223
|
| Min. Negotiated Rate |
$11,077.21 |
| Max. Negotiated Rate |
$11,077.21 |
| Rate for Payer: AHCCCS Medicaid |
$11,077.21
|
| Rate for Payer: Allwell Medicaid |
$11,077.21
|
| Rate for Payer: AZCH Complete Medicaid |
$11,077.21
|
| Rate for Payer: Banner UC Health Medicaid |
$11,077.21
|
| Rate for Payer: Mercy Care Medicaid |
$11,077.21
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$8,652.47
|
|
|
Service Code
|
APR-DRG 0221
|
| Hospital Charge Code |
APRDRG0224
|
| Min. Negotiated Rate |
$8,652.47 |
| Max. Negotiated Rate |
$8,652.47 |
| Rate for Payer: AHCCCS Medicaid |
$8,652.47
|
| Rate for Payer: Allwell Medicaid |
$8,652.47
|
| Rate for Payer: AZCH Complete Medicaid |
$8,652.47
|
| Rate for Payer: Banner UC Health Medicaid |
$8,652.47
|
| Rate for Payer: Mercy Care Medicaid |
$8,652.47
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$18,163.45
|
|
|
Service Code
|
APR-DRG 0223
|
| Hospital Charge Code |
APRDRG0224
|
| Min. Negotiated Rate |
$18,163.45 |
| Max. Negotiated Rate |
$18,163.45 |
| Rate for Payer: AHCCCS Medicaid |
$18,163.45
|
| Rate for Payer: Allwell Medicaid |
$18,163.45
|
| Rate for Payer: AZCH Complete Medicaid |
$18,163.45
|
| Rate for Payer: Banner UC Health Medicaid |
$18,163.45
|
| Rate for Payer: Mercy Care Medicaid |
$18,163.45
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$40,079.40
|
|
|
Service Code
|
APR-DRG 0224
|
| Hospital Charge Code |
APRDRG0223
|
| Min. Negotiated Rate |
$40,079.40 |
| Max. Negotiated Rate |
$40,079.40 |
| Rate for Payer: AHCCCS Medicaid |
$40,079.40
|
| Rate for Payer: Allwell Medicaid |
$40,079.40
|
| Rate for Payer: AZCH Complete Medicaid |
$40,079.40
|
| Rate for Payer: Banner UC Health Medicaid |
$40,079.40
|
| Rate for Payer: Mercy Care Medicaid |
$40,079.40
|
|
|
Ventricular Shunt Procedures
|
Facility
|
IP
|
$11,077.21
|
|
|
Service Code
|
APR-DRG 0222
|
| Hospital Charge Code |
APRDRG0221
|
| Min. Negotiated Rate |
$11,077.21 |
| Max. Negotiated Rate |
$11,077.21 |
| Rate for Payer: AHCCCS Medicaid |
$11,077.21
|
| Rate for Payer: Allwell Medicaid |
$11,077.21
|
| Rate for Payer: AZCH Complete Medicaid |
$11,077.21
|
| Rate for Payer: Banner UC Health Medicaid |
$11,077.21
|
| Rate for Payer: Mercy Care Medicaid |
$11,077.21
|
|
|
verapamil 80 mg Tab [CQCH]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
105945073
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Bisbee Police All Plans |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Self Pay Self Pay |
$0.07
|
|
|
verapamil 80 mg Tab [CQCH]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
105945073
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Aetna of AZ Medicare |
$0.03
|
| 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 |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.06
|
| 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 |
$0.03
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.07
|
| 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 |
$0.02
|
|
|
VERIFY EXTERNAL NEUROSTIMULATOR
|
Facility
|
OP
|
$2,100.00
|
|
| Hospital Charge Code |
22981863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,890.00
|
| Rate for Payer: Aetna of AZ Medicare |
$588.00
|
| Rate for Payer: Allwell Medicare |
$315.00
|
| Rate for Payer: Amerigroup Medicare |
$315.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$784.35
|
| Rate for Payer: AZCH Complete Medicare |
$315.00
|
| Rate for Payer: Banner UC Health Medicare |
$315.00
|
| Rate for Payer: Bisbee Police All Plans |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,470.00
|
| Rate for Payer: Copperpoint Commercial |
$519.75
|
| Rate for Payer: Health Net of AZ Commercial |
$1,260.00
|
| Rate for Payer: Health Net of AZ Medicare |
$588.00
|
| Rate for Payer: Humana of AZ Medicare |
$315.00
|
| Rate for Payer: Self Pay Self Pay |
$1,680.00
|
| Rate for Payer: TriWest Medicare |
$315.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$1,224.30
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$378.00
|
|
|
VERIFY EXTERNAL NEUROSTIMULATOR
|
Facility
|
IP
|
$2,100.00
|
|
| Hospital Charge Code |
22981863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: Aetna of AZ Commercial |
$1,890.00
|
| Rate for Payer: Bisbee Police All Plans |
$546.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Self Pay Self Pay |
$1,680.00
|
|
|
VERRES NEEDLE
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
22354942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
|
|
VERRES NEEDLE
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
22354942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Aetna of AZ Medicare |
$19.04
|
| Rate for Payer: Allwell Medicare |
$10.20
|
| Rate for Payer: Amerigroup Medicare |
$10.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$25.40
|
| Rate for Payer: AZCH Complete Medicare |
$10.20
|
| Rate for Payer: Banner UC Health Medicare |
$10.20
|
| Rate for Payer: Bisbee Police All Plans |
$17.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$46.24
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.60
|
| Rate for Payer: Copperpoint Commercial |
$16.83
|
| Rate for Payer: Health Net of AZ Commercial |
$40.80
|
| Rate for Payer: Health Net of AZ Medicare |
$19.04
|
| Rate for Payer: Humana of AZ Medicare |
$10.20
|
| Rate for Payer: Self Pay Self Pay |
$54.40
|
| Rate for Payer: TriWest Medicare |
$10.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$39.64
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$12.24
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: AHCCCS Medicaid |
$3,838.06
|
| Rate for Payer: Allwell Medicaid |
$3,838.06
|
| Rate for Payer: AZCH Complete Medicaid |
$3,838.06
|
| Rate for Payer: Banner UC Health Medicaid |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1112
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: AHCCCS Medicaid |
$3,838.06
|
| Rate for Payer: Allwell Medicaid |
$3,838.06
|
| Rate for Payer: AZCH Complete Medicaid |
$3,838.06
|
| Rate for Payer: Banner UC Health Medicaid |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: AHCCCS Medicaid |
$5,340.46
|
| Rate for Payer: Allwell Medicaid |
$5,340.46
|
| Rate for Payer: AZCH Complete Medicaid |
$5,340.46
|
| Rate for Payer: Banner UC Health Medicaid |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: AHCCCS Medicaid |
$4,238.56
|
| Rate for Payer: Allwell Medicaid |
$4,238.56
|
| Rate for Payer: AZCH Complete Medicaid |
$4,238.56
|
| Rate for Payer: Banner UC Health Medicaid |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: AHCCCS Medicaid |
$3,838.06
|
| Rate for Payer: Allwell Medicaid |
$3,838.06
|
| Rate for Payer: AZCH Complete Medicaid |
$3,838.06
|
| Rate for Payer: Banner UC Health Medicaid |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1111
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: AHCCCS Medicaid |
$5,340.46
|
| Rate for Payer: Allwell Medicaid |
$5,340.46
|
| Rate for Payer: AZCH Complete Medicaid |
$5,340.46
|
| Rate for Payer: Banner UC Health Medicaid |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: AHCCCS Medicaid |
$4,238.56
|
| Rate for Payer: Allwell Medicaid |
$4,238.56
|
| Rate for Payer: AZCH Complete Medicaid |
$4,238.56
|
| Rate for Payer: Banner UC Health Medicaid |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$6,980.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$6,980.33 |
| Max. Negotiated Rate |
$6,980.33 |
| Rate for Payer: AHCCCS Medicaid |
$6,980.33
|
| Rate for Payer: Allwell Medicaid |
$6,980.33
|
| Rate for Payer: AZCH Complete Medicaid |
$6,980.33
|
| Rate for Payer: Banner UC Health Medicaid |
$6,980.33
|
| Rate for Payer: Mercy Care Medicaid |
$6,980.33
|
|
