|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$10,873.78
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$10,873.78 |
| Max. Negotiated Rate |
$10,873.78 |
| Rate for Payer: Seven Corners Travel Insurance |
$10,873.78
|
|
|
BOSS 10MM TAPER POST 20MM LONG ARTHROSURFACE
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
28172181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$335.02 |
| Max. Negotiated Rate |
$1,903.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,903.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$338.40
|
| Rate for Payer: Banner UC Health Medicare |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,438.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$338.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$338.40
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,480.50
|
| Rate for Payer: Devoted Health Medicare |
$380.70
|
| Rate for Payer: Humana of AZ Medicare |
$338.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,438.20
|
| Rate for Payer: TriWest Medicare |
$338.40
|
| Rate for Payer: United Healthcare Commercial |
$1,209.78
|
| Rate for Payer: United Healthcare Medicare |
$338.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$335.02
|
|
|
BOSS 10MM TAPER POST 20MM LONG ARTHROSURFACE
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
28172181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,903.50 |
| Max. Negotiated Rate |
$1,903.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,903.50
|
| Rate for Payer: Cash Price |
$1,692.00
|
|
|
BOSS DISPOSABLE DRILL 10MM
|
Facility
|
IP
|
$1,223.00
|
|
| Hospital Charge Code |
27745954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,100.70 |
| Max. Negotiated Rate |
$1,100.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,100.70
|
| Rate for Payer: Cash Price |
$978.40
|
|
|
BOSS DISPOSABLE DRILL 10MM
|
Facility
|
OP
|
$1,223.00
|
|
| Hospital Charge Code |
27745954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$1,100.70 |
| Rate for Payer: Aetna of AZ Commercial |
$1,100.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$195.68
|
| Rate for Payer: Banner UC Health Medicare |
$195.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$831.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$195.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$195.68
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cigna of AZ Commercial |
$856.10
|
| Rate for Payer: Devoted Health Medicare |
$220.14
|
| Rate for Payer: Humana of AZ Medicare |
$195.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$831.64
|
| Rate for Payer: TriWest Medicare |
$195.68
|
| Rate for Payer: United Healthcare Commercial |
$699.56
|
| Rate for Payer: United Healthcare Medicare |
$195.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$193.72
|
|
|
Botox injection
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
27281910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.81 |
| Max. Negotiated Rate |
$3,596.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$139.20
|
| Rate for Payer: Banner UC Health Medicare |
$690.65
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$201.53
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$139.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$139.20
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna of AZ Commercial |
$435.00
|
| Rate for Payer: Devoted Health Medicare |
$156.60
|
| Rate for Payer: Humana of AZ Medicare |
$139.20
|
| Rate for Payer: Mercy Care Medicaid |
$201.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$690.65
|
| Rate for Payer: Seven Corners Travel Insurance |
$3,234.38
|
| Rate for Payer: Southwest Service Administrators UFCW |
$591.60
|
| Rate for Payer: TriWest Medicare |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$3,596.00
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$137.81
|
|
|
Botox injection
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
27281910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$783.00 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Aetna of AZ Commercial |
$783.00
|
| Rate for Payer: Cash Price |
$696.00
|
|
|
Botox (onabotulinumtoxinA) 100 units REC [CQCH]
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
109337996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$92.64
|
| Rate for Payer: Banner UC Health Medicare |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$393.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$92.64
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$92.64
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna of AZ Commercial |
$376.35
|
| Rate for Payer: Devoted Health Medicare |
$104.22
|
| Rate for Payer: Humana of AZ Medicare |
$92.64
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$393.72
|
| Rate for Payer: TriWest Medicare |
$92.64
|
| Rate for Payer: United Healthcare Commercial |
$331.19
|
| Rate for Payer: United Healthcare Medicare |
$92.64
|
| Rate for Payer: Veterans Affairs TRICARE |
$91.71
|
|
|
Botox (onabotulinumtoxinA) 100 units REC [CQCH]
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
109337996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of AZ Commercial |
$521.10
|
| Rate for Payer: Cash Price |
$463.20
|
|
|
Botox (onabotulinumtoxinA) 200 units REC [CQCH]
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
105934816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,042.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$185.28
|
| Rate for Payer: Banner UC Health Medicare |
$185.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$787.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$185.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$185.28
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna of AZ Commercial |
$752.70
|
| Rate for Payer: Devoted Health Medicare |
$208.44
|
| Rate for Payer: Humana of AZ Medicare |
$185.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$787.44
|
| Rate for Payer: TriWest Medicare |
$185.28
|
| Rate for Payer: United Healthcare Commercial |
$662.38
|
| Rate for Payer: United Healthcare Medicare |
$185.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$183.43
|
|
|
Botox (onabotulinumtoxinA) 200 units REC [CQCH]
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
105934816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,042.20 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Aetna of AZ Commercial |
$1,042.20
|
| Rate for Payer: Cash Price |
$926.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,028.73
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1323
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$4,208.40
|
|
|
Service Code
|
APR-DRG 1322
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$4,208.40 |
| Max. Negotiated Rate |
$4,208.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,208.40
|
| Rate for Payer: Mercy Care Medicaid |
$4,208.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,208.40
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$7,028.73
|
|
|
Service Code
|
APR-DRG 1323
|
| Hospital Charge Code |
APRDRG1324
|
| Min. Negotiated Rate |
$7,028.73 |
| Max. Negotiated Rate |
$7,028.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,028.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,028.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,028.73
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,227.51
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$3,174.54
|
|
|
Service Code
|
APR-DRG 1321
|
| Hospital Charge Code |
APRDRG1321
|
| Min. Negotiated Rate |
$3,174.54 |
| Max. Negotiated Rate |
$3,174.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,174.54
|
| Rate for Payer: Mercy Care Medicaid |
$3,174.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,174.54
|
|
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
Facility
|
IP
|
$12,227.51
|
|
|
Service Code
|
APR-DRG 1324
|
| Hospital Charge Code |
APRDRG1322
|
| Min. Negotiated Rate |
$12,227.51 |
| Max. Negotiated Rate |
$12,227.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,227.51
|
| Rate for Payer: Mercy Care Medicaid |
$12,227.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,227.51
|
|
