|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: AHCCCS Medicaid |
$12,227.51
|
| Rate for Payer: Allwell Medicaid |
$12,227.51
|
| Rate for Payer: AZCH Complete Medicaid |
$12,227.51
|
| Rate for Payer: Banner UC Health Medicaid |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
|
|
B.pertussisB.parapertussis PCR LC
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2087564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$378.90 |
| Rate for Payer: Aetna of AZ Commercial |
$378.90
|
| Rate for Payer: Aetna of AZ Medicare |
$117.88
|
| Rate for Payer: AHCCCS Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicare |
$63.15
|
| Rate for Payer: Amerigroup Medicare |
$63.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$157.24
|
| Rate for Payer: AZCH Complete Medicaid |
$35.09
|
| Rate for Payer: AZCH Complete Medicare |
$63.15
|
| Rate for Payer: Banner UC Health Medicaid |
$35.09
|
| Rate for Payer: Banner UC Health Medicare |
$63.15
|
| Rate for Payer: Bisbee Police All Plans |
$109.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$286.28
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cigna of AZ Commercial |
$273.65
|
| Rate for Payer: Copperpoint Commercial |
$104.20
|
| Rate for Payer: Health Net of AZ Commercial |
$252.60
|
| Rate for Payer: Health Net of AZ Medicare |
$117.88
|
| Rate for Payer: Humana of AZ Medicare |
$63.15
|
| Rate for Payer: Mercy Care Medicaid |
$35.09
|
| Rate for Payer: Self Pay Self Pay |
$336.80
|
| Rate for Payer: TriWest Medicare |
$63.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$245.44
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$75.78
|
|
|
B.pertussisB.parapertussis PCR LC
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
2087564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$378.90 |
| Rate for Payer: Aetna of AZ Commercial |
$378.90
|
| Rate for Payer: Bisbee Police All Plans |
$109.46
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Self Pay Self Pay |
$336.80
|
|
|
B pertussis IgA Ab LC
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of AZ Commercial |
$234.00
|
| Rate for Payer: Bisbee Police All Plans |
$67.60
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Self Pay Self Pay |
$208.00
|
|
|
B pertussis IgA Ab LC
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of AZ Commercial |
$234.00
|
| Rate for Payer: Aetna of AZ Medicare |
$72.80
|
| Rate for Payer: AHCCCS Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicare |
$39.00
|
| Rate for Payer: Amerigroup Medicare |
$39.00
|
| Rate for Payer: APIPA Medicare/Medicaid |
$97.11
|
| Rate for Payer: AZCH Complete Medicaid |
$13.19
|
| Rate for Payer: AZCH Complete Medicare |
$39.00
|
| Rate for Payer: Banner UC Health Medicaid |
$13.19
|
| Rate for Payer: Banner UC Health Medicare |
$39.00
|
| Rate for Payer: Bisbee Police All Plans |
$67.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$176.80
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna of AZ Commercial |
$169.00
|
| Rate for Payer: Copperpoint Commercial |
$64.35
|
| Rate for Payer: Health Net of AZ Commercial |
$156.00
|
| Rate for Payer: Health Net of AZ Medicare |
$72.80
|
| Rate for Payer: Humana of AZ Medicare |
$39.00
|
| Rate for Payer: Mercy Care Medicaid |
$13.19
|
| Rate for Payer: Self Pay Self Pay |
$208.00
|
| Rate for Payer: TriWest Medicare |
$39.00
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$151.58
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$46.80
|
|
|
B pertussis IgG Ab LC
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2087563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of AZ Commercial |
$240.30
|
| Rate for Payer: Bisbee Police All Plans |
$69.42
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Self Pay Self Pay |
$213.60
|
|
|
B pertussis IgG Ab LC
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
2087563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Aetna of AZ Commercial |
$240.30
|
| Rate for Payer: Aetna of AZ Medicare |
$74.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicare |
$40.05
|
| Rate for Payer: Amerigroup Medicare |
$40.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$99.72
|
| Rate for Payer: AZCH Complete Medicaid |
$13.19
|
| Rate for Payer: AZCH Complete Medicare |
$40.05
|
| Rate for Payer: Banner UC Health Medicaid |
$13.19
|
| Rate for Payer: Banner UC Health Medicare |
$40.05
|
| Rate for Payer: Bisbee Police All Plans |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$181.56
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna of AZ Commercial |
$173.55
|
| Rate for Payer: Copperpoint Commercial |
$66.08
|
| Rate for Payer: Health Net of AZ Commercial |
$160.20
|
| Rate for Payer: Health Net of AZ Medicare |
$74.76
|
| Rate for Payer: Humana of AZ Medicare |
$40.05
|
| Rate for Payer: Mercy Care Medicaid |
$13.19
|
| Rate for Payer: Self Pay Self Pay |
$213.60
|
| Rate for Payer: TriWest Medicare |
$40.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$155.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$48.06
|
|
|
B pertussis IgG/IgM Ab LC
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22201710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Aetna of AZ Commercial |
$360.90
|
| Rate for Payer: Aetna of AZ Medicare |
$112.28
|
| Rate for Payer: AHCCCS Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicaid |
$35.09
|
| Rate for Payer: Allwell Medicare |
$60.15
|
| Rate for Payer: Amerigroup Medicare |
$60.15
|
| Rate for Payer: APIPA Medicare/Medicaid |
$149.77
|
| Rate for Payer: AZCH Complete Medicaid |
$35.09
|
| Rate for Payer: AZCH Complete Medicare |
$60.15
|
| Rate for Payer: Banner UC Health Medicaid |
$35.09
|
| Rate for Payer: Banner UC Health Medicare |
$60.15
|
| Rate for Payer: Bisbee Police All Plans |
$104.26
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$272.68
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cigna of AZ Commercial |
$260.65
|
| Rate for Payer: Copperpoint Commercial |
$99.25
|
| Rate for Payer: Health Net of AZ Commercial |
$240.60
|
| Rate for Payer: Health Net of AZ Medicare |
$112.28
|
| Rate for Payer: Humana of AZ Medicare |
$60.15
|
| Rate for Payer: Mercy Care Medicaid |
$35.09
|
| Rate for Payer: Self Pay Self Pay |
$320.80
|
| Rate for Payer: TriWest Medicare |
$60.15
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$233.78
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$72.18
|
|
|
B pertussis IgG/IgM Ab LC
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
22201710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.26 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Aetna of AZ Commercial |
$360.90
|
| Rate for Payer: Bisbee Police All Plans |
$104.26
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Self Pay Self Pay |
$320.80
|
|
|
B pertussis IgM Ab LC
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
|
|
B pertussis IgM Ab LC
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
22311177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna of AZ Commercial |
$262.80
|
| Rate for Payer: Aetna of AZ Medicare |
$81.76
|
| Rate for Payer: AHCCCS Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicaid |
$13.19
|
| Rate for Payer: Allwell Medicare |
$43.80
|
| Rate for Payer: Amerigroup Medicare |
$43.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$109.06
|
| Rate for Payer: AZCH Complete Medicaid |
$13.19
|
| Rate for Payer: AZCH Complete Medicare |
$43.80
|
| Rate for Payer: Banner UC Health Medicaid |
$13.19
|
| Rate for Payer: Banner UC Health Medicare |
$43.80
|
| Rate for Payer: Bisbee Police All Plans |
$75.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$198.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cigna of AZ Commercial |
$189.80
|
| Rate for Payer: Copperpoint Commercial |
$72.27
|
| Rate for Payer: Health Net of AZ Commercial |
$175.20
|
| Rate for Payer: Health Net of AZ Medicare |
$81.76
|
| Rate for Payer: Humana of AZ Medicare |
$43.80
|
| Rate for Payer: Mercy Care Medicaid |
$13.19
|
| Rate for Payer: Self Pay Self Pay |
$233.60
|
| Rate for Payer: TriWest Medicare |
$43.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$170.24
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$52.56
|
|
|
B Pertussis, Nasophar Culture
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2269430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Aetna of AZ Medicare |
$59.36
|
| Rate for Payer: AHCCCS Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicaid |
$8.62
|
| Rate for Payer: Allwell Medicare |
$31.80
|
| Rate for Payer: Amerigroup Medicare |
$31.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$79.18
|
| Rate for Payer: AZCH Complete Medicaid |
$8.62
|
| Rate for Payer: AZCH Complete Medicare |
$31.80
|
| Rate for Payer: Banner UC Health Medicaid |
$8.62
|
| Rate for Payer: Banner UC Health Medicare |
$31.80
|
| Rate for Payer: Bisbee Police All Plans |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$144.16
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cigna of AZ Commercial |
$137.80
|
| Rate for Payer: Copperpoint Commercial |
$52.47
|
| Rate for Payer: Health Net of AZ Commercial |
$127.20
|
| Rate for Payer: Health Net of AZ Medicare |
$59.36
|
| Rate for Payer: Humana of AZ Medicare |
$31.80
|
| Rate for Payer: Mercy Care Medicaid |
$8.62
|
| Rate for Payer: Self Pay Self Pay |
$169.60
|
| Rate for Payer: TriWest Medicare |
$31.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$123.60
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$38.16
|
|
|
B Pertussis, Nasophar Culture
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
2269430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of AZ Commercial |
$190.80
|
| Rate for Payer: Bisbee Police All Plans |
$55.12
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Self Pay Self Pay |
$169.60
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: AHCCCS Medicaid |
$4,353.59
|
| Rate for Payer: Allwell Medicaid |
$4,353.59
|
| Rate for Payer: AZCH Complete Medicaid |
$4,353.59
|
| Rate for Payer: Banner UC Health Medicaid |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$9,988.64
|
|
|
Service Code
|
APR-DRG 0563
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$9,988.64 |
| Max. Negotiated Rate |
$9,988.64 |
| Rate for Payer: AHCCCS Medicaid |
$9,988.64
|
| Rate for Payer: Allwell Medicaid |
$9,988.64
|
| Rate for Payer: AZCH Complete Medicaid |
$9,988.64
|
| Rate for Payer: Banner UC Health Medicaid |
$9,988.64
|
| Rate for Payer: Mercy Care Medicaid |
$9,988.64
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,264.90
|
|
|
Service Code
|
APR-DRG 0562
|
| Hospital Charge Code |
APRDRG0564
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: AHCCCS Medicaid |
$6,264.90
|
| Rate for Payer: Allwell Medicaid |
$6,264.90
|
| Rate for Payer: AZCH Complete Medicaid |
$6,264.90
|
| Rate for Payer: Banner UC Health Medicaid |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0561
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: AHCCCS Medicaid |
$4,353.59
|
| Rate for Payer: Allwell Medicaid |
$4,353.59
|
| Rate for Payer: AZCH Complete Medicaid |
$4,353.59
|
| Rate for Payer: Banner UC Health Medicaid |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0561
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: AHCCCS Medicaid |
$18,725.28
|
| Rate for Payer: Allwell Medicaid |
$18,725.28
|
| Rate for Payer: AZCH Complete Medicaid |
$18,725.28
|
| Rate for Payer: Banner UC Health Medicaid |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$9,988.64
|
|
|
Service Code
|
APR-DRG 0563
|
| Hospital Charge Code |
APRDRG0561
|
| Min. Negotiated Rate |
$9,988.64 |
| Max. Negotiated Rate |
$9,988.64 |
| Rate for Payer: AHCCCS Medicaid |
$9,988.64
|
| Rate for Payer: Allwell Medicaid |
$9,988.64
|
| Rate for Payer: AZCH Complete Medicaid |
$9,988.64
|
| Rate for Payer: Banner UC Health Medicaid |
$9,988.64
|
| Rate for Payer: Mercy Care Medicaid |
$9,988.64
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: AHCCCS Medicaid |
$18,725.28
|
| Rate for Payer: Allwell Medicaid |
$18,725.28
|
| Rate for Payer: AZCH Complete Medicaid |
$18,725.28
|
| Rate for Payer: Banner UC Health Medicaid |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$18,725.28
|
|
|
Service Code
|
APR-DRG 0564
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$18,725.28 |
| Max. Negotiated Rate |
$18,725.28 |
| Rate for Payer: AHCCCS Medicaid |
$18,725.28
|
| Rate for Payer: Allwell Medicaid |
$18,725.28
|
| Rate for Payer: AZCH Complete Medicaid |
$18,725.28
|
| Rate for Payer: Banner UC Health Medicaid |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$9,988.64
|
|
|
Service Code
|
APR-DRG 0563
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$9,988.64 |
| Max. Negotiated Rate |
$9,988.64 |
| Rate for Payer: AHCCCS Medicaid |
$9,988.64
|
| Rate for Payer: Allwell Medicaid |
$9,988.64
|
| Rate for Payer: AZCH Complete Medicaid |
$9,988.64
|
| Rate for Payer: Banner UC Health Medicaid |
$9,988.64
|
| Rate for Payer: Mercy Care Medicaid |
$9,988.64
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: AHCCCS Medicaid |
$4,353.59
|
| Rate for Payer: Allwell Medicaid |
$4,353.59
|
| Rate for Payer: AZCH Complete Medicaid |
$4,353.59
|
| Rate for Payer: Banner UC Health Medicaid |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,353.59
|
|
|
Service Code
|
APR-DRG 0561
|
| Hospital Charge Code |
APRDRG0562
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: AHCCCS Medicaid |
$4,353.59
|
| Rate for Payer: Allwell Medicaid |
$4,353.59
|
| Rate for Payer: AZCH Complete Medicaid |
$4,353.59
|
| Rate for Payer: Banner UC Health Medicaid |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
|
|
Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,264.90
|
|
|
Service Code
|
APR-DRG 0562
|
| Hospital Charge Code |
APRDRG0563
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: AHCCCS Medicaid |
$6,264.90
|
| Rate for Payer: Allwell Medicaid |
$6,264.90
|
| Rate for Payer: AZCH Complete Medicaid |
$6,264.90
|
| Rate for Payer: Banner UC Health Medicaid |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
|
