|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$26,241.48
|
|
|
Service Code
|
APR-DRG 1632
|
| Hospital Charge Code |
APRDRG1631
|
| Min. Negotiated Rate |
$26,241.48 |
| Max. Negotiated Rate |
$26,241.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,241.48
|
| Rate for Payer: Mercy Care Medicaid |
$26,241.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,241.48
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,736.78
|
|
|
Service Code
|
APR-DRG 1631
|
| Hospital Charge Code |
APRDRG1631
|
| Min. Negotiated Rate |
$23,736.78 |
| Max. Negotiated Rate |
$23,736.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,736.78
|
| Rate for Payer: Mercy Care Medicaid |
$23,736.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,736.78
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,985.83
|
|
|
Service Code
|
APR-DRG 1633
|
| Hospital Charge Code |
APRDRG1633
|
| Min. Negotiated Rate |
$34,985.83 |
| Max. Negotiated Rate |
$34,985.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,985.83
|
| Rate for Payer: Mercy Care Medicaid |
$34,985.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,985.83
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,985.83
|
|
|
Service Code
|
APR-DRG 1633
|
| Hospital Charge Code |
APRDRG1632
|
| Min. Negotiated Rate |
$34,985.83 |
| Max. Negotiated Rate |
$34,985.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,985.83
|
| Rate for Payer: Mercy Care Medicaid |
$34,985.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,985.83
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$54,932.95
|
|
|
Service Code
|
APR-DRG 1634
|
| Hospital Charge Code |
APRDRG1634
|
| Min. Negotiated Rate |
$54,932.95 |
| Max. Negotiated Rate |
$54,932.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$54,932.95
|
| Rate for Payer: Mercy Care Medicaid |
$54,932.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$54,932.95
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,985.83
|
|
|
Service Code
|
APR-DRG 1633
|
| Hospital Charge Code |
APRDRG1634
|
| Min. Negotiated Rate |
$34,985.83 |
| Max. Negotiated Rate |
$34,985.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,985.83
|
| Rate for Payer: Mercy Care Medicaid |
$34,985.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,985.83
|
|
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$54,932.95
|
|
|
Service Code
|
APR-DRG 1634
|
| Hospital Charge Code |
APRDRG1632
|
| Min. Negotiated Rate |
$54,932.95 |
| Max. Negotiated Rate |
$54,932.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$54,932.95
|
| Rate for Payer: Mercy Care Medicaid |
$54,932.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$54,932.95
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$6,686.45
|
|
|
Service Code
|
APR-DRG 2053
|
| Hospital Charge Code |
APRDRG2053
|
| Min. Negotiated Rate |
$6,686.45 |
| Max. Negotiated Rate |
$6,686.45 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,686.45
|
| Rate for Payer: Mercy Care Medicaid |
$6,686.45
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,686.45
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 2052
|
| Hospital Charge Code |
APRDRG2054
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$3,612.91
|
|
|
Service Code
|
APR-DRG 2051
|
| Hospital Charge Code |
APRDRG2052
|
| Min. Negotiated Rate |
$3,612.91 |
| Max. Negotiated Rate |
$3,612.91 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,612.91
|
| Rate for Payer: Mercy Care Medicaid |
$3,612.91
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,612.91
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$3,612.91
|
|
|
Service Code
|
APR-DRG 2051
|
| Hospital Charge Code |
APRDRG2051
|
| Min. Negotiated Rate |
$3,612.91 |
| Max. Negotiated Rate |
$3,612.91 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,612.91
|
| Rate for Payer: Mercy Care Medicaid |
$3,612.91
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,612.91
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$6,686.45
|
|
|
Service Code
|
APR-DRG 2053
|
| Hospital Charge Code |
APRDRG2051
|
| Min. Negotiated Rate |
$6,686.45 |
| Max. Negotiated Rate |
$6,686.45 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,686.45
|
| Rate for Payer: Mercy Care Medicaid |
$6,686.45
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,686.45
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 2052
|
| Hospital Charge Code |
APRDRG2052
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$13,234.02
|
|
|
Service Code
|
APR-DRG 2054
|
| Hospital Charge Code |
APRDRG2053
|
| Min. Negotiated Rate |
$13,234.02 |
| Max. Negotiated Rate |
$13,234.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,234.02
|
| Rate for Payer: Mercy Care Medicaid |
$13,234.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,234.02
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$3,612.91
|
|
|
Service Code
|
APR-DRG 2051
|
| Hospital Charge Code |
APRDRG2053
|
| Min. Negotiated Rate |
$3,612.91 |
| Max. Negotiated Rate |
$3,612.91 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,612.91
|
| Rate for Payer: Mercy Care Medicaid |
$3,612.91
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,612.91
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$13,234.02
|
|
|
Service Code
|
APR-DRG 2054
|
| Hospital Charge Code |
APRDRG2054
|
| Min. Negotiated Rate |
$13,234.02 |
| Max. Negotiated Rate |
$13,234.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,234.02
|
| Rate for Payer: Mercy Care Medicaid |
$13,234.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,234.02
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$6,686.45
|
|
|
Service Code
|
APR-DRG 2053
|
| Hospital Charge Code |
APRDRG2052
|
| Min. Negotiated Rate |
$6,686.45 |
| Max. Negotiated Rate |
$6,686.45 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,686.45
|
| Rate for Payer: Mercy Care Medicaid |
$6,686.45
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,686.45
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$13,234.02
|
|
|
Service Code
|
APR-DRG 2054
|
| Hospital Charge Code |
APRDRG2051
|
| Min. Negotiated Rate |
$13,234.02 |
| Max. Negotiated Rate |
$13,234.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,234.02
|
| Rate for Payer: Mercy Care Medicaid |
$13,234.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,234.02
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$3,612.91
|
|
|
Service Code
|
APR-DRG 2051
|
| Hospital Charge Code |
APRDRG2054
|
| Min. Negotiated Rate |
$3,612.91 |
| Max. Negotiated Rate |
$3,612.91 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,612.91
|
| Rate for Payer: Mercy Care Medicaid |
$3,612.91
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,612.91
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$6,686.45
|
|
|
Service Code
|
APR-DRG 2053
|
| Hospital Charge Code |
APRDRG2054
|
| Min. Negotiated Rate |
$6,686.45 |
| Max. Negotiated Rate |
$6,686.45 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,686.45
|
| Rate for Payer: Mercy Care Medicaid |
$6,686.45
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,686.45
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 2052
|
| Hospital Charge Code |
APRDRG2051
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
APR-DRG 2052
|
| Hospital Charge Code |
APRDRG2053
|
| Min. Negotiated Rate |
$4,557.00 |
| Max. Negotiated Rate |
$4,557.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,557.00
|
| Rate for Payer: Mercy Care Medicaid |
$4,557.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,557.00
|
|
|
Cardiomyopathy
|
Facility
|
IP
|
$13,234.02
|
|
|
Service Code
|
APR-DRG 2054
|
| Hospital Charge Code |
APRDRG2052
|
| Min. Negotiated Rate |
$13,234.02 |
| Max. Negotiated Rate |
$13,234.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,234.02
|
| Rate for Payer: Mercy Care Medicaid |
$13,234.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,234.02
|
|
|
carisoprodol 350 mg Tab [CQCH]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 63739004910
|
| Hospital Charge Code |
105914652
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.02
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Devoted Health Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.07
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.02
|
|
|
carisoprodol 350 mg Tab [CQCH]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 63739004910
|
| Hospital Charge Code |
105914652
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
|
