hospital_name,last_updated_on,version,location_name,hospital_address,license_number|AZ,type_2_npi,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,general_contract_provisions,Header is,,,,,,,,,,,
GUIDANCE CENTER INC,10/1/2025,3.0.0,GUIDANCE CENTER INC,"2187 N. Vickey Street Flagstaff, AZ 86004",158133,1316014459,TRUE,Devon Forrest,,TRUE,,,,,,,,,,,
description,code | 1,code | 1 | type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge | gross,standard_charge | discounted_cash,payer_name,plan_name,modifiers,standard_charge | negotiated_dollar,standard_charge | negotiated_percentage,standard_charge | negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge | min,standard_charge | max,standard_charge | methodology,additional_generic_notes
Psych Room And Board,0124,CPT,inpatient,,,1560,1224,Navajo Nation,HMO,,1560,,,160.42,,,,1224,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,1200,BCBS,PPO,,1560,,,160.42,,,,1200,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,1560,Self Pay,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,764,UBH Commercial,HMO,,1560,,,160.42,,,,764,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,816.39,UHC AZ Medicaid,HMO,,1560,,,160.42,,,,816.39,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,816.39,UHC LTC AZ Medicaid,HMO,,1560,,,160.42,,,,816.39,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,1224.59,Care 1st,HMO,,1560,,,160.42,,,,1224.59,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,800,Medicare,HMO,,1560,,,160.42,,,,800,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,816.39,AHCCCS Fee For Service,HMO,,1560,,,160.42,,,,816.39,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,816.39,Mercy Care,HMO,,1560,,,160.42,,,,816.39,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,1365,Health Choice ACC,HMO,,1560,,,160.42,,,,1365,1560,fee schedule,
Psych Room And Board,0124,CPT,inpatient,,,1560,1347.04,Coconino County T36,HMO,,1560,,,160.42,,,,1347.04,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,1560,Self Pay,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,1224,Navajo Nation,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,1200,BCBS,PPO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,1224,Health Choice ACC,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,752,UBH Commercial,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,739.87,UHC AZ Medicaid,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,739.87,UHC LTC AZ Medicaid,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,1109.81,Care 1st,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,800,Medicare,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,739.87,AHCCCS Fee For Service,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Detox Semi Private,0126,CPT,inpatient,,,1560,739.87,Mercy Care,HMO,,1560,,,160.42,,,,1560,1560,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,Self Pay,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3,Navajo Nation,HMO,,3.9,,,160.42,,,,3,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3,BCBS,PPO,,3.9,,,160.42,,,,3,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3,Health Choice ACC,HMO,,3.9,,,160.42,,,,3,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,UBH Commercial,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,Medicare,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,AHCCCS Fee For Service,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,Mercy Care,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,UHC AZ Medicaid,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,UHC LTC AZ Medicaid,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
Ancillary Services,0900,CPT,inpatient,,,3.9,3.9,Care 1st,HMO,,3.9,,,160.42,,,,3.9,3.9,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,260.23,Self Pay,HMO,,260.23,,,160.42,,,,260.23,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,143.02,Navajo Nation,HMO,,260.23,,,160.42,,,,143.02,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,117.08,BCBS,PPO,,260.23,,,160.42,,,,117.08,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,117.08,UBH Commercial,HMO,,260.23,,,160.42,,,,117.08,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,80.21,UHC LTC AZ Medicaid,HMO,,260.23,,,160.42,,,,80.21,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,145.88,Coconino County T36,HMO,,260.23,,,160.42,,,,145.88,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,229.55,UHC AZ Medicaid,HMO,,260.23,,,160.42,,,,229.55,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,98.86,Medicare,HMO,,260.23,,,160.42,,,,98.86,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,113.33,Mercy Care,HMO,,260.23,,,160.42,,,,113.33,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,89.89,AHCCCS Fee For Service,HMO,,260.23,,,160.42,,,,89.89,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,184.27,Care 1st,HMO,,260.23,,,160.42,,,,184.27,260.23,fee schedule,
INITIAL HOSPITAL CARE,99221,CPT,inpatient,,,260.23,89.89,Health Choice ACC,HMO,,260.23,,,160.42,,,,89.89,260.23,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,238.36,Navajo Nation,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,309.87,Self Pay,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,108.32,UHC LTC AZ Medicaid,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,158.25,BCBS,PPO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,158.25,UBH Commercial,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,243.13,Coconino County T36,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,311.11,UHC AZ Medicaid,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,133.19,Medicare,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,156.04,Mercy Care,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,121.22,AHCCCS Fee For Service,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,248.5,Care 1st,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99222,CPT,inpatient,,,309.87,121.22,Health Choice ACC,HMO,,309.87,,,160.42,,,,238.36,238.36,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,433.81,Self Pay,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,333.7,Navajo Nation,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,160.42,UHC LTC AZ Medicaid,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,233.78,BCBS,PPO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,233.78,UBH Commercial,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,340.37,Health Choice ACC,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,340.37,Coconino County T36,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,454.21,UHC AZ Medicaid,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,196.15,Medicare,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,224.98,Mercy Care,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,177.56,AHCCCS Fee For Service,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
INITIAL HOSPITAL CARE,99223,CPT,inpatient,,,433.81,364,Care 1st,HMO,,433.81,,,160.42,,,,320.84,320.84,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,92.96,Self Pay,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,71.51,Navajo Nation,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,30.82,UHC LTC AZ Medicaid,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,45.51,BCBS,PPO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,45.51,UBH Commercial,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,72.94,Coconino County T36,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,88.66,UHC AZ Medicaid,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,37.64,Medicare,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,46.32,Mercy Care,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,34.82,AHCCCS Fee For Service,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,71.38,Care 1st,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99231,CPT,inpatient,,,92.96,34.82,Health Choice ACC,HMO,,92.96,,,160.42,,,,61.64,61.64,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,154.93,Self Pay,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,119.18,Navajo Nation,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,57.17,UHC LTC AZ Medicaid,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,83.33,BCBS,PPO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,83.33,UBH Commercial,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,121.56,Coconino County T36,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,160.55,UHC AZ Medicaid,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,70.41,Medicare,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,78.84,Mercy Care,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,63.93,AHCCCS Fee For Service,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,131.06,Care 1st,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99232,CPT,inpatient,,,194.7,63.93,Health Choice ACC,HMO,,194.7,,,160.42,,,,72.47,72.47,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,223.46,Self Pay,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,171.89,Navajo Nation,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,82.36,UHC LTC AZ Medicaid,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,120.22,BCBS,PPO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,120.22,UBH Commercial,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,175.33,Coconino County T36,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,233.45,UHC AZ Medicaid,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,101.18,Medicare,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,115.19,Mercy Care,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,91.79,AHCCCS Fee For Service,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,91.79,Health Choice ACC,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
SUBSEQUENT HOSPITAL CARE,99233,CPT,inpatient,,,281.34,183.38,Care 1st,HMO,,281.34,,,160.42,,,,164.72,164.72,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,288.5,Self Pay,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,221.92,Navajo Nation,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,105.78,UHC LTC AZ Medicaid,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,154.17,BCBS,PPO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,154.17,UBH Commercial,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,306.34,UHC AZ Medicaid,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,128.79,Medicare,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,192.67,Mercy Care,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,116.79,AHCCCS Fee For Service,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,239.42,Care 1st,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,116.79,Health Choice ACC,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99234,CPT,inpatient,,,288.5,191.45,Coconino County T36,HMO,,288.5,,,160.42,,,,104.79,104.79,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,380.34,Self Pay,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,292.57,Navajo Nation,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,133.61,UHC LTC AZ Medicaid,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,195.29,BCBS,PPO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,195.29,UBH Commercial,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,382.11,UHC AZ Medicaid,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,163.73,Medicare,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,252.5,Mercy Care,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,148.12,AHCCCS Fee For Service,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,303.65,Care 1st,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,148.12,Health Choice ACC,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99235,CPT,inpatient,,,380.34,298.42,Coconino County T36,HMO,,380.34,,,160.42,,,,267.22,267.22,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,433.81,Self Pay,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,333.7,Navajo Nation,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,172.25,UHC LTC AZ Medicaid,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,251.53,BCBS,PPO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,251.53,UBH Commercial,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,492.14,UHC AZ Medicaid,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,210.27,Medicare,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,315.07,Mercy Care,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,189.9,AHCCCS Fee For Service,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,389.3,Care 1st,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,189.9,Health Choice ACC,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
OBSERV/HOSP SAME DATE,99236,CPT,inpatient,,,433.81,298.42,Coconino County T36,HMO,,433.81,,,160.42,,,,135,135,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,143.02,Navajo Nation,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,185.93,Self Pay,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,57.73,UHC LTC AZ Medicaid,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,83.79,BCBS,PPO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,83.79,UBH Commercial,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,145.88,Coconino County T36,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,161.17,UHC AZ Medicaid,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,70.58,Medicare,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,96.79,Mercy Care,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,64.25,AHCCCS Fee For Service,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,131.71,Care 1st,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99238,CPT,inpatient,,,185.93,64.25,Health Choice ACC,HMO,,185.93,,,160.42,,,,185.93,185.93,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,371.84,Self Pay,HMO,,371.84,,,160.42,,,,371.84,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,286.03,Navajo Nation,HMO,,371.84,,,160.42,,,,286.03,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,84.96,UHC LTC AZ Medicaid,HMO,,371.84,,,160.42,,,,84.96,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,124.04,BCBS,PPO,,371.84,,,160.42,,,,124.04,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,124.04,UBH Commercial,HMO,,371.84,,,160.42,,,,124.04,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,291.75,Coconino County T36,HMO,,371.84,,,160.42,,,,291.75,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,238.59,UHC AZ Medicaid,HMO,,371.84,,,160.42,,,,238.59,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,104.03,Medicare,HMO,,371.84,,,160.42,,,,104.03,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,132.15,Mercy Care,HMO,,371.84,,,160.42,,,,132.15,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,94,AHCCCS Fee For Service,HMO,,371.84,,,160.42,,,,94,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,192.7,Care 1st,HMO,,371.84,,,160.42,,,,192.7,371.84,fee schedule,
HOSPITAL DISCHARGE DAY,99239,CPT,inpatient,,,371.84,94,Health Choice ACC,HMO,,371.84,,,160.42,,,,94,371.84,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,247.9,Self Pay,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,190.69,Navajo Nation,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,59.64,UHC LTC AZ Medicaid,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,138.42,BCBS,PPO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,138.42,UBH Commercial,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,170.27,UHC AZ Medicaid,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,100.63,Mercy Care,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,66.15,AHCCCS Fee For Service,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99252,CPT,inpatient,,,247.9,135.61,Care 1st,HMO,,247.9,,,160.42,,,,247.9,247.9,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,340.85,Self Pay,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,262.19,Navajo Nation,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,91.09,UHC LTC AZ Medicaid,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,159.05,BCBS,PPO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,159.05,UBH Commercial,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,260.53,UHC AZ Medicaid,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,137.31,Mercy Care,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,102.55,AHCCCS Fee For Service,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,210.23,Care 1st,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99253,CPT,inpatient,,,340.85,102.55,Health Choice ACC,HMO,,340.85,,,160.42,,,,90.81,90.81,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,495.78,Self Pay,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,381.37,Navajo Nation,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,131.56,UHC LTC AZ Medicaid,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,197.33,BCBS,PPO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,197.33,UBH Commercial,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,129.94,Medicare,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,376.03,UHC AZ Medicaid,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,197.92,Mercy Care,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,147.81,AHCCCS Fee For Service,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,303.01,Care 1st,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,
INPATIENT CONSULTATION,99254,CPT,inpatient,,,495.78,147.81,Health Choice ACC,HMO,,495.78,,,160.42,,,,376.03,376.03,fee schedule,