|
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: Blue Cross Blue Shield of Arizona Health Choice |
$18,725.28
|
| Rate for Payer: Mercy Care Medicaid |
$18,725.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$18,725.28
|
|
|
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 |
APRDRG0561
|
| Min. Negotiated Rate |
$6,264.90 |
| Max. Negotiated Rate |
$6,264.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,264.90
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$6,264.90
|
| Rate for Payer: Mercy Care Medicaid |
$6,264.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG0562
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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 |
APRDRG0563
|
| Min. Negotiated Rate |
$4,353.59 |
| Max. Negotiated Rate |
$4,353.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,353.59
|
| Rate for Payer: Mercy Care Medicaid |
$4,353.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,353.59
|
|
|
Brain Natriuretic Peptide (BNP)
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
785967
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Aetna of AZ Commercial |
$431.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$77.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$76.64
|
| Rate for Payer: Banner UC Health Medicare |
$76.64
|
| Rate for Payer: Banner UC Health Medicare |
$77.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$325.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$76.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$77.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$77.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$76.64
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cigna of AZ Commercial |
$311.35
|
| Rate for Payer: Cigna of AZ Commercial |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$86.22
|
| Rate for Payer: Devoted Health Medicare |
$87.30
|
| Rate for Payer: Humana of AZ Medicare |
$76.64
|
| Rate for Payer: Humana of AZ Medicare |
$77.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$56.93
|
| Rate for Payer: Seven Corners Travel Insurance |
$56.93
|
| Rate for Payer: Southwest Service Administrators UFCW |
$325.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$329.80
|
| Rate for Payer: TriWest Medicare |
$76.64
|
| Rate for Payer: TriWest Medicare |
$77.60
|
| Rate for Payer: United Healthcare Commercial |
$277.42
|
| Rate for Payer: United Healthcare Commercial |
$273.99
|
| Rate for Payer: United Healthcare Medicare |
$76.64
|
| Rate for Payer: United Healthcare Medicare |
$77.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$75.87
|
| Rate for Payer: Veterans Affairs TRICARE |
$76.82
|
|
|
Brain Natriuretic Peptide (BNP)
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
785967
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$431.10 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna of AZ Commercial |
$431.10
|
| Rate for Payer: Aetna of AZ Commercial |
$436.50
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$388.00
|
|
|
BRAVA SKIN OSTOMY BARRIER
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
27575453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
|
|
BRAVA SKIN OSTOMY BARRIER
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
27575453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of AZ Commercial |
$28.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.12
|
| Rate for Payer: Banner UC Health Medicare |
$5.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$21.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.12
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cigna of AZ Commercial |
$22.40
|
| Rate for Payer: Devoted Health Medicare |
$5.76
|
| Rate for Payer: Humana of AZ Medicare |
$5.12
|
| Rate for Payer: Southwest Service Administrators UFCW |
$21.76
|
| Rate for Payer: TriWest Medicare |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$18.30
|
| Rate for Payer: United Healthcare Medicare |
$5.12
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.07
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$27,666.70
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$27,666.70 |
| Max. Negotiated Rate |
$27,666.70 |
| Rate for Payer: Seven Corners Travel Insurance |
$27,666.70
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,931.97
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$24,931.97 |
| Max. Negotiated Rate |
$24,931.97 |
| Rate for Payer: Seven Corners Travel Insurance |
$24,931.97
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,104.68
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,151.33
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,151.33
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,972.59
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$13,972.59
|
| Rate for Payer: Mercy Care Medicaid |
$13,972.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,972.59
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,104.68
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$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: Blue Cross Blue Shield of Arizona Health Choice |
$8,104.68
|
| Rate for Payer: Mercy Care Medicaid |
$8,104.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,104.68
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24,191.29
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$24,191.29
|
| Rate for Payer: Mercy Care Medicaid |
$24,191.29
|
| Rate for Payer: NaphCare Correctional Healthcare |
$24,191.29
|
|
|
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: Blue Cross Blue Shield of Arizona Health Choice |
$17,151.33
|
| Rate for Payer: Mercy Care Medicaid |
$17,151.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,151.33
|
|
