|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$4,059.70
|
|
|
Service Code
|
APR-DRG 1982
|
| Hospital Charge Code |
APRDRG1982
|
| Min. Negotiated Rate |
$4,059.70 |
| Max. Negotiated Rate |
$4,059.70 |
| Rate for Payer: AHCCCS Medicaid |
$4,059.70
|
| Rate for Payer: Allwell Medicaid |
$4,059.70
|
| Rate for Payer: AZCH Complete Medicaid |
$4,059.70
|
| Rate for Payer: Banner UC Health Medicaid |
$4,059.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,059.70
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$5,420.42
|
|
|
Service Code
|
APR-DRG 1983
|
| Hospital Charge Code |
APRDRG1982
|
| Min. Negotiated Rate |
$5,420.42 |
| Max. Negotiated Rate |
$5,420.42 |
| Rate for Payer: AHCCCS Medicaid |
$5,420.42
|
| Rate for Payer: Allwell Medicaid |
$5,420.42
|
| Rate for Payer: AZCH Complete Medicaid |
$5,420.42
|
| Rate for Payer: Banner UC Health Medicaid |
$5,420.42
|
| Rate for Payer: Mercy Care Medicaid |
$5,420.42
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$4,059.70
|
|
|
Service Code
|
APR-DRG 1982
|
| Hospital Charge Code |
APRDRG1981
|
| Min. Negotiated Rate |
$4,059.70 |
| Max. Negotiated Rate |
$4,059.70 |
| Rate for Payer: AHCCCS Medicaid |
$4,059.70
|
| Rate for Payer: Allwell Medicaid |
$4,059.70
|
| Rate for Payer: AZCH Complete Medicaid |
$4,059.70
|
| Rate for Payer: Banner UC Health Medicaid |
$4,059.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,059.70
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$10,514.69
|
|
|
Service Code
|
APR-DRG 1984
|
| Hospital Charge Code |
APRDRG1982
|
| Min. Negotiated Rate |
$10,514.69 |
| Max. Negotiated Rate |
$10,514.69 |
| Rate for Payer: AHCCCS Medicaid |
$10,514.69
|
| Rate for Payer: Allwell Medicaid |
$10,514.69
|
| Rate for Payer: AZCH Complete Medicaid |
$10,514.69
|
| Rate for Payer: Banner UC Health Medicaid |
$10,514.69
|
| Rate for Payer: Mercy Care Medicaid |
$10,514.69
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$10,514.69
|
|
|
Service Code
|
APR-DRG 1984
|
| Hospital Charge Code |
APRDRG1984
|
| Min. Negotiated Rate |
$10,514.69 |
| Max. Negotiated Rate |
$10,514.69 |
| Rate for Payer: AHCCCS Medicaid |
$10,514.69
|
| Rate for Payer: Allwell Medicaid |
$10,514.69
|
| Rate for Payer: AZCH Complete Medicaid |
$10,514.69
|
| Rate for Payer: Banner UC Health Medicaid |
$10,514.69
|
| Rate for Payer: Mercy Care Medicaid |
$10,514.69
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$5,420.42
|
|
|
Service Code
|
APR-DRG 1983
|
| Hospital Charge Code |
APRDRG1983
|
| Min. Negotiated Rate |
$5,420.42 |
| Max. Negotiated Rate |
$5,420.42 |
| Rate for Payer: AHCCCS Medicaid |
$5,420.42
|
| Rate for Payer: Allwell Medicaid |
$5,420.42
|
| Rate for Payer: AZCH Complete Medicaid |
$5,420.42
|
| Rate for Payer: Banner UC Health Medicaid |
$5,420.42
|
| Rate for Payer: Mercy Care Medicaid |
$5,420.42
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$3,483.85
|
|
|
Service Code
|
APR-DRG 1981
|
| Hospital Charge Code |
APRDRG1982
|
| Min. Negotiated Rate |
$3,483.85 |
| Max. Negotiated Rate |
$3,483.85 |
| Rate for Payer: AHCCCS Medicaid |
$3,483.85
|
| Rate for Payer: Allwell Medicaid |
$3,483.85
|
| Rate for Payer: AZCH Complete Medicaid |
$3,483.85
|
| Rate for Payer: Banner UC Health Medicaid |
$3,483.85
|
| Rate for Payer: Mercy Care Medicaid |
$3,483.85
|
|
|
Angina Pectoris And Coronary Atherosclerosis
|
Facility
|
IP
|
$5,420.42
|
|
|
Service Code
|
APR-DRG 1983
|
| Hospital Charge Code |
APRDRG1984
|
| Min. Negotiated Rate |
$5,420.42 |
| Max. Negotiated Rate |
$5,420.42 |
| Rate for Payer: AHCCCS Medicaid |
$5,420.42
|
| Rate for Payer: Allwell Medicaid |
$5,420.42
|
| Rate for Payer: AZCH Complete Medicaid |
$5,420.42
|
| Rate for Payer: Banner UC Health Medicaid |
$5,420.42
|
| Rate for Payer: Mercy Care Medicaid |
$5,420.42
|
|
|
Angiotensin-Converting Enzyme LC
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
1905918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of AZ Commercial |
$243.00
|
| Rate for Payer: Bisbee Police All Plans |
$70.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Self Pay Self Pay |
$216.00
|
|
|
Angiotensin-Converting Enzyme LC
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
1905918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of AZ Commercial |
$243.00
|
| Rate for Payer: Aetna of AZ Medicare |
$75.60
|
| Rate for Payer: Allwell Medicare |
$43.20
|
| Rate for Payer: Amerigroup Medicare |
$43.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$100.84
|
| Rate for Payer: AZCH Complete Medicare |
$43.20
|
| Rate for Payer: Banner UC Health Medicare |
$43.20
|
| Rate for Payer: Bisbee Police All Plans |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$183.60
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of AZ Commercial |
$175.50
|
| Rate for Payer: Copperpoint Commercial |
$66.83
|
| Rate for Payer: Health Net of AZ Commercial |
$162.00
|
| Rate for Payer: Health Net of AZ Medicare |
$75.60
|
| Rate for Payer: Humana of AZ Medicare |
$43.20
|
| Rate for Payer: Self Pay Self Pay |
$216.00
|
| Rate for Payer: TriWest Medicare |
$43.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$157.41
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.60
|
|
|
ANOSCOPY
|
Facility
|
OP
|
$243.00
|
|
| Hospital Charge Code |
2263852
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of AZ Commercial |
$218.70
|
| Rate for Payer: Aetna of AZ Medicare |
$68.04
|
| Rate for Payer: Allwell Medicare |
$38.88
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: APIPA Medicare/Medicaid |
$90.76
|
| Rate for Payer: AZCH Complete Medicare |
$38.88
|
| Rate for Payer: Banner UC Health Medicare |
$38.88
|
| Rate for Payer: Bisbee Police All Plans |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$165.24
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of AZ Commercial |
$170.10
|
| Rate for Payer: Copperpoint Commercial |
$60.14
|
| Rate for Payer: Health Net of AZ Commercial |
$145.80
|
| Rate for Payer: Health Net of AZ Medicare |
$68.04
|
| Rate for Payer: Humana of AZ Medicare |
$38.88
|
| Rate for Payer: Self Pay Self Pay |
$194.40
|
| Rate for Payer: TriWest Medicare |
$38.88
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$141.67
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$43.74
|
|
|
ANOSCOPY
|
Facility
|
IP
|
$243.00
|
|
| Hospital Charge Code |
2263852
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Aetna of AZ Commercial |
$218.70
|
| Rate for Payer: Bisbee Police All Plans |
$63.18
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Self Pay Self Pay |
$194.40
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$9,846.25
|
|
|
Service Code
|
APR-DRG 0593
|
| Hospital Charge Code |
APRDRG0591
|
| Min. Negotiated Rate |
$9,846.25 |
| Max. Negotiated Rate |
$9,846.25 |
| Rate for Payer: AHCCCS Medicaid |
$9,846.25
|
| Rate for Payer: Allwell Medicaid |
$9,846.25
|
| Rate for Payer: AZCH Complete Medicaid |
$9,846.25
|
| Rate for Payer: Banner UC Health Medicaid |
$9,846.25
|
| Rate for Payer: Mercy Care Medicaid |
$9,846.25
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$4,263.11
|
|
|
Service Code
|
APR-DRG 0591
|
| Hospital Charge Code |
APRDRG0591
|
| Min. Negotiated Rate |
$4,263.11 |
| Max. Negotiated Rate |
$4,263.11 |
| Rate for Payer: AHCCCS Medicaid |
$4,263.11
|
| Rate for Payer: Allwell Medicaid |
$4,263.11
|
| Rate for Payer: AZCH Complete Medicaid |
$4,263.11
|
| Rate for Payer: Banner UC Health Medicaid |
$4,263.11
|
| Rate for Payer: Mercy Care Medicaid |
$4,263.11
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$9,846.25
|
|
|
Service Code
|
APR-DRG 0593
|
| Hospital Charge Code |
APRDRG0593
|
| Min. Negotiated Rate |
$9,846.25 |
| Max. Negotiated Rate |
$9,846.25 |
| Rate for Payer: AHCCCS Medicaid |
$9,846.25
|
| Rate for Payer: Allwell Medicaid |
$9,846.25
|
| Rate for Payer: AZCH Complete Medicaid |
$9,846.25
|
| Rate for Payer: Banner UC Health Medicaid |
$9,846.25
|
| Rate for Payer: Mercy Care Medicaid |
$9,846.25
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$6,748.87
|
|
|
Service Code
|
APR-DRG 0592
|
| Hospital Charge Code |
APRDRG0593
|
| Min. Negotiated Rate |
$6,748.87 |
| Max. Negotiated Rate |
$6,748.87 |
| Rate for Payer: AHCCCS Medicaid |
$6,748.87
|
| Rate for Payer: Allwell Medicaid |
$6,748.87
|
| Rate for Payer: AZCH Complete Medicaid |
$6,748.87
|
| Rate for Payer: Banner UC Health Medicaid |
$6,748.87
|
| Rate for Payer: Mercy Care Medicaid |
$6,748.87
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$9,846.25
|
|
|
Service Code
|
APR-DRG 0593
|
| Hospital Charge Code |
APRDRG0594
|
| Min. Negotiated Rate |
$9,846.25 |
| Max. Negotiated Rate |
$9,846.25 |
| Rate for Payer: AHCCCS Medicaid |
$9,846.25
|
| Rate for Payer: Allwell Medicaid |
$9,846.25
|
| Rate for Payer: AZCH Complete Medicaid |
$9,846.25
|
| Rate for Payer: Banner UC Health Medicaid |
$9,846.25
|
| Rate for Payer: Mercy Care Medicaid |
$9,846.25
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$6,748.87
|
|
|
Service Code
|
APR-DRG 0592
|
| Hospital Charge Code |
APRDRG0594
|
| Min. Negotiated Rate |
$6,748.87 |
| Max. Negotiated Rate |
$6,748.87 |
| Rate for Payer: AHCCCS Medicaid |
$6,748.87
|
| Rate for Payer: Allwell Medicaid |
$6,748.87
|
| Rate for Payer: AZCH Complete Medicaid |
$6,748.87
|
| Rate for Payer: Banner UC Health Medicaid |
$6,748.87
|
| Rate for Payer: Mercy Care Medicaid |
$6,748.87
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$6,748.87
|
|
|
Service Code
|
APR-DRG 0592
|
| Hospital Charge Code |
APRDRG0591
|
| Min. Negotiated Rate |
$6,748.87 |
| Max. Negotiated Rate |
$6,748.87 |
| Rate for Payer: AHCCCS Medicaid |
$6,748.87
|
| Rate for Payer: Allwell Medicaid |
$6,748.87
|
| Rate for Payer: AZCH Complete Medicaid |
$6,748.87
|
| Rate for Payer: Banner UC Health Medicaid |
$6,748.87
|
| Rate for Payer: Mercy Care Medicaid |
$6,748.87
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$15,379.60
|
|
|
Service Code
|
APR-DRG 0594
|
| Hospital Charge Code |
APRDRG0593
|
| Min. Negotiated Rate |
$15,379.60 |
| Max. Negotiated Rate |
$15,379.60 |
| Rate for Payer: AHCCCS Medicaid |
$15,379.60
|
| Rate for Payer: Allwell Medicaid |
$15,379.60
|
| Rate for Payer: AZCH Complete Medicaid |
$15,379.60
|
| Rate for Payer: Banner UC Health Medicaid |
$15,379.60
|
| Rate for Payer: Mercy Care Medicaid |
$15,379.60
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$6,748.87
|
|
|
Service Code
|
APR-DRG 0592
|
| Hospital Charge Code |
APRDRG0592
|
| Min. Negotiated Rate |
$6,748.87 |
| Max. Negotiated Rate |
$6,748.87 |
| Rate for Payer: AHCCCS Medicaid |
$6,748.87
|
| Rate for Payer: Allwell Medicaid |
$6,748.87
|
| Rate for Payer: AZCH Complete Medicaid |
$6,748.87
|
| Rate for Payer: Banner UC Health Medicaid |
$6,748.87
|
| Rate for Payer: Mercy Care Medicaid |
$6,748.87
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$4,263.11
|
|
|
Service Code
|
APR-DRG 0591
|
| Hospital Charge Code |
APRDRG0593
|
| Min. Negotiated Rate |
$4,263.11 |
| Max. Negotiated Rate |
$4,263.11 |
| Rate for Payer: AHCCCS Medicaid |
$4,263.11
|
| Rate for Payer: Allwell Medicaid |
$4,263.11
|
| Rate for Payer: AZCH Complete Medicaid |
$4,263.11
|
| Rate for Payer: Banner UC Health Medicaid |
$4,263.11
|
| Rate for Payer: Mercy Care Medicaid |
$4,263.11
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$4,263.11
|
|
|
Service Code
|
APR-DRG 0591
|
| Hospital Charge Code |
APRDRG0594
|
| Min. Negotiated Rate |
$4,263.11 |
| Max. Negotiated Rate |
$4,263.11 |
| Rate for Payer: AHCCCS Medicaid |
$4,263.11
|
| Rate for Payer: Allwell Medicaid |
$4,263.11
|
| Rate for Payer: AZCH Complete Medicaid |
$4,263.11
|
| Rate for Payer: Banner UC Health Medicaid |
$4,263.11
|
| Rate for Payer: Mercy Care Medicaid |
$4,263.11
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$15,379.60
|
|
|
Service Code
|
APR-DRG 0594
|
| Hospital Charge Code |
APRDRG0594
|
| Min. Negotiated Rate |
$15,379.60 |
| Max. Negotiated Rate |
$15,379.60 |
| Rate for Payer: AHCCCS Medicaid |
$15,379.60
|
| Rate for Payer: Allwell Medicaid |
$15,379.60
|
| Rate for Payer: AZCH Complete Medicaid |
$15,379.60
|
| Rate for Payer: Banner UC Health Medicaid |
$15,379.60
|
| Rate for Payer: Mercy Care Medicaid |
$15,379.60
|
|
|
Anoxic And Other Severe Brain Damage
|
Facility
|
IP
|
$15,379.60
|
|
|
Service Code
|
APR-DRG 0594
|
| Hospital Charge Code |
APRDRG0592
|
| Min. Negotiated Rate |
$15,379.60 |
| Max. Negotiated Rate |
$15,379.60 |
| Rate for Payer: AHCCCS Medicaid |
$15,379.60
|
| Rate for Payer: Allwell Medicaid |
$15,379.60
|
| Rate for Payer: AZCH Complete Medicaid |
$15,379.60
|
| Rate for Payer: Banner UC Health Medicaid |
$15,379.60
|
| Rate for Payer: Mercy Care Medicaid |
$15,379.60
|
|
