|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
|
IP
|
$92,154.30
|
|
|
Service Code
|
MSDRG 275
|
| Min. Negotiated Rate |
$92,154.30 |
| Max. Negotiated Rate |
$92,154.30 |
| Rate for Payer: Seven Corners Travel Insurance |
$92,154.30
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR
|
Facility
|
IP
|
$77,630.11
|
|
|
Service Code
|
MSDRG 276
|
| Min. Negotiated Rate |
$77,630.11 |
| Max. Negotiated Rate |
$77,630.11 |
| Rate for Payer: Seven Corners Travel Insurance |
$77,630.11
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
|
IP
|
$59,690.13
|
|
|
Service Code
|
MSDRG 277
|
| Min. Negotiated Rate |
$59,690.13 |
| Max. Negotiated Rate |
$59,690.13 |
| Rate for Payer: Seven Corners Travel Insurance |
$59,690.13
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$23,051.51
|
|
|
Service Code
|
APR-DRG 1774
|
| Hospital Charge Code |
APRDRG1774
|
| Min. Negotiated Rate |
$23,051.51 |
| Max. Negotiated Rate |
$23,051.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,051.51
|
| Rate for Payer: Mercy Care Medicaid |
$23,051.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,051.51
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$12,373.40
|
|
|
Service Code
|
APR-DRG 1772
|
| Hospital Charge Code |
APRDRG1774
|
| Min. Negotiated Rate |
$12,373.40 |
| Max. Negotiated Rate |
$12,373.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,373.40
|
| Rate for Payer: Mercy Care Medicaid |
$12,373.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,373.40
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$8,442.05
|
|
|
Service Code
|
APR-DRG 1771
|
| Hospital Charge Code |
APRDRG1772
|
| Min. Negotiated Rate |
$8,442.05 |
| Max. Negotiated Rate |
$8,442.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,442.05
|
| Rate for Payer: Mercy Care Medicaid |
$8,442.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,442.05
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$16,929.69
|
|
|
Service Code
|
APR-DRG 1773
|
| Hospital Charge Code |
APRDRG1774
|
| Min. Negotiated Rate |
$16,929.69 |
| Max. Negotiated Rate |
$16,929.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,929.69
|
| Rate for Payer: Mercy Care Medicaid |
$16,929.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,929.69
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$12,373.40
|
|
|
Service Code
|
APR-DRG 1772
|
| Hospital Charge Code |
APRDRG1771
|
| Min. Negotiated Rate |
$12,373.40 |
| Max. Negotiated Rate |
$12,373.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,373.40
|
| Rate for Payer: Mercy Care Medicaid |
$12,373.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,373.40
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$8,442.05
|
|
|
Service Code
|
APR-DRG 1771
|
| Hospital Charge Code |
APRDRG1773
|
| Min. Negotiated Rate |
$8,442.05 |
| Max. Negotiated Rate |
$8,442.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,442.05
|
| Rate for Payer: Mercy Care Medicaid |
$8,442.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,442.05
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$16,929.69
|
|
|
Service Code
|
APR-DRG 1773
|
| Hospital Charge Code |
APRDRG1771
|
| Min. Negotiated Rate |
$16,929.69 |
| Max. Negotiated Rate |
$16,929.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,929.69
|
| Rate for Payer: Mercy Care Medicaid |
$16,929.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,929.69
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$23,051.51
|
|
|
Service Code
|
APR-DRG 1774
|
| Hospital Charge Code |
APRDRG1772
|
| Min. Negotiated Rate |
$23,051.51 |
| Max. Negotiated Rate |
$23,051.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,051.51
|
| Rate for Payer: Mercy Care Medicaid |
$23,051.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,051.51
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$8,442.05
|
|
|
Service Code
|
APR-DRG 1771
|
| Hospital Charge Code |
APRDRG1771
|
| Min. Negotiated Rate |
$8,442.05 |
| Max. Negotiated Rate |
$8,442.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,442.05
|
| Rate for Payer: Mercy Care Medicaid |
$8,442.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,442.05
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$12,373.40
|
|
|
Service Code
|
APR-DRG 1772
|
| Hospital Charge Code |
APRDRG1773
|
| Min. Negotiated Rate |
$12,373.40 |
| Max. Negotiated Rate |
$12,373.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,373.40
|
| Rate for Payer: Mercy Care Medicaid |
$12,373.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,373.40
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$12,373.40
|
|
|
Service Code
|
APR-DRG 1772
|
| Hospital Charge Code |
APRDRG1772
|
| Min. Negotiated Rate |
$12,373.40 |
| Max. Negotiated Rate |
$12,373.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,373.40
|
| Rate for Payer: Mercy Care Medicaid |
$12,373.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,373.40
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$8,442.05
|
|
|
Service Code
|
APR-DRG 1771
|
| Hospital Charge Code |
APRDRG1774
|
| Min. Negotiated Rate |
$8,442.05 |
| Max. Negotiated Rate |
$8,442.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,442.05
|
| Rate for Payer: Mercy Care Medicaid |
$8,442.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,442.05
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$23,051.51
|
|
|
Service Code
|
APR-DRG 1774
|
| Hospital Charge Code |
APRDRG1773
|
| Min. Negotiated Rate |
$23,051.51 |
| Max. Negotiated Rate |
$23,051.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,051.51
|
| Rate for Payer: Mercy Care Medicaid |
$23,051.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,051.51
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$16,929.69
|
|
|
Service Code
|
APR-DRG 1773
|
| Hospital Charge Code |
APRDRG1773
|
| Min. Negotiated Rate |
$16,929.69 |
| Max. Negotiated Rate |
$16,929.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,929.69
|
| Rate for Payer: Mercy Care Medicaid |
$16,929.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,929.69
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$23,051.51
|
|
|
Service Code
|
APR-DRG 1774
|
| Hospital Charge Code |
APRDRG1771
|
| Min. Negotiated Rate |
$23,051.51 |
| Max. Negotiated Rate |
$23,051.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,051.51
|
| Rate for Payer: Mercy Care Medicaid |
$23,051.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,051.51
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$16,929.69
|
|
|
Service Code
|
APR-DRG 1773
|
| Hospital Charge Code |
APRDRG1772
|
| Min. Negotiated Rate |
$16,929.69 |
| Max. Negotiated Rate |
$16,929.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,929.69
|
| Rate for Payer: Mercy Care Medicaid |
$16,929.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,929.69
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$40,608.93
|
|
|
Service Code
|
MSDRG 258
|
| Min. Negotiated Rate |
$40,608.93 |
| Max. Negotiated Rate |
$40,608.93 |
| Rate for Payer: Seven Corners Travel Insurance |
$40,608.93
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
|
IP
|
$26,133.92
|
|
|
Service Code
|
MSDRG 259
|
| Min. Negotiated Rate |
$26,133.92 |
| Max. Negotiated Rate |
$26,133.92 |
| Rate for Payer: Seven Corners Travel Insurance |
$26,133.92
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
|
IP
|
$24,433.07
|
|
|
Service Code
|
MSDRG 261
|
| Min. Negotiated Rate |
$24,433.07 |
| Max. Negotiated Rate |
$24,433.07 |
| Rate for Payer: Seven Corners Travel Insurance |
$24,433.07
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$42,039.65
|
|
|
Service Code
|
MSDRG 260
|
| Min. Negotiated Rate |
$42,039.65 |
| Max. Negotiated Rate |
$42,039.65 |
| Rate for Payer: Seven Corners Travel Insurance |
$42,039.65
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$21,065.03
|
|
|
Service Code
|
MSDRG 262
|
| Min. Negotiated Rate |
$21,065.03 |
| Max. Negotiated Rate |
$21,065.03 |
| Rate for Payer: Seven Corners Travel Insurance |
$21,065.03
|
|
|
Cardiac Panel 2
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
2483894
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna of AZ Commercial |
$265.50
|
| Rate for Payer: Cash Price |
$236.00
|
|
