|
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
|
$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 |
APRDRG0564
|
| 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 |
APRDRG0562
|
| 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 Natriuretic Peptide (BNP)
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
785967
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna of AZ Commercial |
$459.00
|
| Rate for Payer: Aetna of AZ Medicare |
$142.80
|
| Rate for Payer: AHCCCS Medicaid |
$39.26
|
| Rate for Payer: Allwell Medicaid |
$39.26
|
| Rate for Payer: Allwell Medicare |
$76.50
|
| Rate for Payer: Amerigroup Medicare |
$76.50
|
| Rate for Payer: APIPA Medicare/Medicaid |
$190.48
|
| Rate for Payer: AZCH Complete Medicaid |
$39.26
|
| Rate for Payer: AZCH Complete Medicare |
$76.50
|
| Rate for Payer: Banner UC Health Medicaid |
$39.26
|
| Rate for Payer: Banner UC Health Medicare |
$76.50
|
| Rate for Payer: Bisbee Police All Plans |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$346.80
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna of AZ Commercial |
$331.50
|
| Rate for Payer: Copperpoint Commercial |
$126.22
|
| Rate for Payer: Health Net of AZ Commercial |
$306.00
|
| Rate for Payer: Health Net of AZ Medicare |
$142.80
|
| Rate for Payer: Humana of AZ Medicare |
$76.50
|
| Rate for Payer: Mercy Care Medicaid |
$39.26
|
| Rate for Payer: Self Pay Self Pay |
$408.00
|
| Rate for Payer: TriWest Medicare |
$76.50
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$297.33
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$91.80
|
|
|
Brain Natriuretic Peptide (BNP)
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
785967
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna of AZ Commercial |
$459.00
|
| Rate for Payer: Bisbee Police All Plans |
$132.60
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Self Pay Self Pay |
$408.00
|
|
|
BRAVA SKIN OSTOMY BARRIER
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
27575453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Aetna of AZ Medicare |
$8.96
|
| Rate for Payer: Allwell Medicare |
$4.80
|
| Rate for Payer: Amerigroup Medicare |
$4.80
|
| Rate for Payer: APIPA Medicare/Medicaid |
$11.95
|
| Rate for Payer: AZCH Complete Medicare |
$4.80
|
| Rate for Payer: Banner UC Health Medicare |
$4.80
|
| Rate for Payer: Bisbee Police All Plans |
$8.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$21.76
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cigna of AZ Commercial |
$22.40
|
| Rate for Payer: Copperpoint Commercial |
$7.92
|
| Rate for Payer: Health Net of AZ Commercial |
$19.20
|
| Rate for Payer: Health Net of AZ Medicare |
$8.96
|
| Rate for Payer: Humana of AZ Medicare |
$4.80
|
| Rate for Payer: Self Pay Self Pay |
$25.60
|
| Rate for Payer: TriWest Medicare |
$4.80
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$18.66
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$5.76
|
|
|
BRAVA SKIN OSTOMY BARRIER
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
27575453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Bisbee Police All Plans |
$8.32
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Self Pay Self Pay |
$25.60
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$24,191.29
|
|
|
Service Code
|
APR-DRG 3634
|
| Hospital Charge Code |
APRDRG3633
|
| Min. Negotiated Rate |
$24,191.29 |
| Max. Negotiated Rate |
$24,191.29 |
| Rate for Payer: AHCCCS Medicaid |
$24,191.29
|
| Rate for Payer: Allwell Medicaid |
$24,191.29
|
| Rate for Payer: AZCH Complete Medicaid |
$24,191.29
|
| Rate for Payer: Banner UC Health Medicaid |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$17,151.33
|
|
|
Service Code
|
APR-DRG 3633
|
| Hospital Charge Code |
APRDRG3634
|
| Min. Negotiated Rate |
$17,151.33 |
| Max. Negotiated Rate |
$17,151.33 |
| Rate for Payer: AHCCCS Medicaid |
$17,151.33
|
| Rate for Payer: Allwell Medicaid |
$17,151.33
|
| Rate for Payer: AZCH Complete Medicaid |
$17,151.33
|
| Rate for Payer: Banner UC Health Medicaid |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$17,151.33
|
|
|
Service Code
|
APR-DRG 3633
|
| Hospital Charge Code |
APRDRG3631
|
| Min. Negotiated Rate |
$17,151.33 |
| Max. Negotiated Rate |
$17,151.33 |
| Rate for Payer: AHCCCS Medicaid |
$17,151.33
|
| Rate for Payer: Allwell Medicaid |
$17,151.33
|
| Rate for Payer: AZCH Complete Medicaid |
$17,151.33
|
| Rate for Payer: Banner UC Health Medicaid |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$8,104.68
|
|
|
Service Code
|
APR-DRG 3631
|
| Hospital Charge Code |
APRDRG3631
|
| Min. Negotiated Rate |
$8,104.68 |
| Max. Negotiated Rate |
$8,104.68 |
| Rate for Payer: AHCCCS Medicaid |
$8,104.68
|
| Rate for Payer: Allwell Medicaid |
$8,104.68
|
| Rate for Payer: AZCH Complete Medicaid |
$8,104.68
|
| Rate for Payer: Banner UC Health Medicaid |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$13,972.59
|
|
|
Service Code
|
APR-DRG 3632
|
| Hospital Charge Code |
APRDRG3634
|
| Min. Negotiated Rate |
$13,972.59 |
| Max. Negotiated Rate |
$13,972.59 |
| Rate for Payer: AHCCCS Medicaid |
$13,972.59
|
| Rate for Payer: Allwell Medicaid |
$13,972.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13,972.59
|
| Rate for Payer: Banner UC Health Medicaid |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$24,191.29
|
|
|
Service Code
|
APR-DRG 3634
|
| Hospital Charge Code |
APRDRG3631
|
| Min. Negotiated Rate |
$24,191.29 |
| Max. Negotiated Rate |
$24,191.29 |
| Rate for Payer: AHCCCS Medicaid |
$24,191.29
|
| Rate for Payer: Allwell Medicaid |
$24,191.29
|
| Rate for Payer: AZCH Complete Medicaid |
$24,191.29
|
| Rate for Payer: Banner UC Health Medicaid |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$13,972.59
|
|
|
Service Code
|
APR-DRG 3632
|
| Hospital Charge Code |
APRDRG3631
|
| Min. Negotiated Rate |
$13,972.59 |
| Max. Negotiated Rate |
$13,972.59 |
| Rate for Payer: AHCCCS Medicaid |
$13,972.59
|
| Rate for Payer: Allwell Medicaid |
$13,972.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13,972.59
|
| Rate for Payer: Banner UC Health Medicaid |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$8,104.68
|
|
|
Service Code
|
APR-DRG 3631
|
| Hospital Charge Code |
APRDRG3633
|
| Min. Negotiated Rate |
$8,104.68 |
| Max. Negotiated Rate |
$8,104.68 |
| Rate for Payer: AHCCCS Medicaid |
$8,104.68
|
| Rate for Payer: Allwell Medicaid |
$8,104.68
|
| Rate for Payer: AZCH Complete Medicaid |
$8,104.68
|
| Rate for Payer: Banner UC Health Medicaid |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$17,151.33
|
|
|
Service Code
|
APR-DRG 3633
|
| Hospital Charge Code |
APRDRG3633
|
| Min. Negotiated Rate |
$17,151.33 |
| Max. Negotiated Rate |
$17,151.33 |
| Rate for Payer: AHCCCS Medicaid |
$17,151.33
|
| Rate for Payer: Allwell Medicaid |
$17,151.33
|
| Rate for Payer: AZCH Complete Medicaid |
$17,151.33
|
| Rate for Payer: Banner UC Health Medicaid |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$17,151.33
|
|
|
Service Code
|
APR-DRG 3633
|
| Hospital Charge Code |
APRDRG3632
|
| Min. Negotiated Rate |
$17,151.33 |
| Max. Negotiated Rate |
$17,151.33 |
| Rate for Payer: AHCCCS Medicaid |
$17,151.33
|
| Rate for Payer: Allwell Medicaid |
$17,151.33
|
| Rate for Payer: AZCH Complete Medicaid |
$17,151.33
|
| Rate for Payer: Banner UC Health Medicaid |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$24,191.29
|
|
|
Service Code
|
APR-DRG 3634
|
| Hospital Charge Code |
APRDRG3632
|
| Min. Negotiated Rate |
$24,191.29 |
| Max. Negotiated Rate |
$24,191.29 |
| Rate for Payer: AHCCCS Medicaid |
$24,191.29
|
| Rate for Payer: Allwell Medicaid |
$24,191.29
|
| Rate for Payer: AZCH Complete Medicaid |
$24,191.29
|
| Rate for Payer: Banner UC Health Medicaid |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$13,972.59
|
|
|
Service Code
|
APR-DRG 3632
|
| Hospital Charge Code |
APRDRG3632
|
| Min. Negotiated Rate |
$13,972.59 |
| Max. Negotiated Rate |
$13,972.59 |
| Rate for Payer: AHCCCS Medicaid |
$13,972.59
|
| Rate for Payer: Allwell Medicaid |
$13,972.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13,972.59
|
| Rate for Payer: Banner UC Health Medicaid |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$13,972.59
|
|
|
Service Code
|
APR-DRG 3632
|
| Hospital Charge Code |
APRDRG3633
|
| Min. Negotiated Rate |
$13,972.59 |
| Max. Negotiated Rate |
$13,972.59 |
| Rate for Payer: AHCCCS Medicaid |
$13,972.59
|
| Rate for Payer: Allwell Medicaid |
$13,972.59
|
| Rate for Payer: AZCH Complete Medicaid |
$13,972.59
|
| Rate for Payer: Banner UC Health Medicaid |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$24,191.29
|
|
|
Service Code
|
APR-DRG 3634
|
| Hospital Charge Code |
APRDRG3634
|
| Min. Negotiated Rate |
$24,191.29 |
| Max. Negotiated Rate |
$24,191.29 |
| Rate for Payer: AHCCCS Medicaid |
$24,191.29
|
| Rate for Payer: Allwell Medicaid |
$24,191.29
|
| Rate for Payer: AZCH Complete Medicaid |
$24,191.29
|
| Rate for Payer: Banner UC Health Medicaid |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$8,104.68
|
|
|
Service Code
|
APR-DRG 3631
|
| Hospital Charge Code |
APRDRG3632
|
| Min. Negotiated Rate |
$8,104.68 |
| Max. Negotiated Rate |
$8,104.68 |
| Rate for Payer: AHCCCS Medicaid |
$8,104.68
|
| Rate for Payer: Allwell Medicaid |
$8,104.68
|
| Rate for Payer: AZCH Complete Medicaid |
$8,104.68
|
| Rate for Payer: Banner UC Health Medicaid |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
|
|
Breast Procedures Except Mastectomy
|
Facility
|
IP
|
$8,104.68
|
|
|
Service Code
|
APR-DRG 3631
|
| Hospital Charge Code |
APRDRG3634
|
| Min. Negotiated Rate |
$8,104.68 |
| Max. Negotiated Rate |
$8,104.68 |
| Rate for Payer: AHCCCS Medicaid |
$8,104.68
|
| Rate for Payer: Allwell Medicaid |
$8,104.68
|
| Rate for Payer: AZCH Complete Medicaid |
$8,104.68
|
| Rate for Payer: Banner UC Health Medicaid |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
|
|
BREATHING CIRCUIT
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
22355324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna of AZ Commercial |
$24.30
|
| Rate for Payer: Aetna of AZ Medicare |
$7.56
|
| Rate for Payer: Allwell Medicare |
$4.05
|
| Rate for Payer: Amerigroup Medicare |
$4.05
|
| Rate for Payer: APIPA Medicare/Medicaid |
$10.08
|
| Rate for Payer: AZCH Complete Medicare |
$4.05
|
| Rate for Payer: Banner UC Health Medicare |
$4.05
|
| Rate for Payer: Bisbee Police All Plans |
$7.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of AZ Commercial |
$18.90
|
| Rate for Payer: Copperpoint Commercial |
$6.68
|
| Rate for Payer: Health Net of AZ Commercial |
$16.20
|
| Rate for Payer: Health Net of AZ Medicare |
$7.56
|
| Rate for Payer: Humana of AZ Medicare |
$4.05
|
| Rate for Payer: Self Pay Self Pay |
$21.60
|
| Rate for Payer: TriWest Medicare |
$4.05
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$15.74
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$4.86
|
|
