|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$12,504.55
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$12,504.55 |
| Max. Negotiated Rate |
$12,504.55 |
| Rate for Payer: Seven Corners Travel Insurance |
$12,504.55
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
|
Service Code
|
APR-DRG 5392
|
| Hospital Charge Code |
APRDRG5392
|
| Min. Negotiated Rate |
$4,119.32 |
| Max. Negotiated Rate |
$4,119.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,119.32
|
| Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,119.32
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
|
Service Code
|
APR-DRG 5391
|
| Hospital Charge Code |
APRDRG5393
|
| Min. Negotiated Rate |
$3,573.63 |
| Max. Negotiated Rate |
$3,573.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,573.63
|
| Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,573.63
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
|
Service Code
|
APR-DRG 5392
|
| Hospital Charge Code |
APRDRG5393
|
| Min. Negotiated Rate |
$4,119.32 |
| Max. Negotiated Rate |
$4,119.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,119.32
|
| Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,119.32
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
|
Service Code
|
APR-DRG 5391
|
| Hospital Charge Code |
APRDRG5394
|
| Min. Negotiated Rate |
$3,573.63 |
| Max. Negotiated Rate |
$3,573.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,573.63
|
| Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,573.63
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
|
Service Code
|
APR-DRG 5394
|
| Hospital Charge Code |
APRDRG5394
|
| Min. Negotiated Rate |
$16,231.80 |
| Max. Negotiated Rate |
$16,231.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,231.80
|
| Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,231.80
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
|
Service Code
|
APR-DRG 5394
|
| Hospital Charge Code |
APRDRG5392
|
| Min. Negotiated Rate |
$16,231.80 |
| Max. Negotiated Rate |
$16,231.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,231.80
|
| Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,231.80
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
|
Service Code
|
APR-DRG 5392
|
| Hospital Charge Code |
APRDRG5391
|
| Min. Negotiated Rate |
$4,119.32 |
| Max. Negotiated Rate |
$4,119.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,119.32
|
| Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,119.32
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
|
Service Code
|
APR-DRG 5391
|
| Hospital Charge Code |
APRDRG5391
|
| Min. Negotiated Rate |
$3,573.63 |
| Max. Negotiated Rate |
$3,573.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,573.63
|
| Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,573.63
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
|
Service Code
|
APR-DRG 5393
|
| Hospital Charge Code |
APRDRG5393
|
| Min. Negotiated Rate |
$6,450.07 |
| Max. Negotiated Rate |
$6,450.07 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,450.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,450.07
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
|
Service Code
|
APR-DRG 5393
|
| Hospital Charge Code |
APRDRG5391
|
| Min. Negotiated Rate |
$6,450.07 |
| Max. Negotiated Rate |
$6,450.07 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,450.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,450.07
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
|
Service Code
|
APR-DRG 5393
|
| Hospital Charge Code |
APRDRG5392
|
| Min. Negotiated Rate |
$6,450.07 |
| Max. Negotiated Rate |
$6,450.07 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,450.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,450.07
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
|
Service Code
|
APR-DRG 5394
|
| Hospital Charge Code |
APRDRG5391
|
| Min. Negotiated Rate |
$16,231.80 |
| Max. Negotiated Rate |
$16,231.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,231.80
|
| Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,231.80
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$4,119.32
|
|
|
Service Code
|
APR-DRG 5392
|
| Hospital Charge Code |
APRDRG5394
|
| Min. Negotiated Rate |
$4,119.32 |
| Max. Negotiated Rate |
$4,119.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,119.32
|
| Rate for Payer: Mercy Care Medicaid |
$4,119.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,119.32
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$6,450.07
|
|
|
Service Code
|
APR-DRG 5393
|
| Hospital Charge Code |
APRDRG5394
|
| Min. Negotiated Rate |
$6,450.07 |
| Max. Negotiated Rate |
$6,450.07 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,450.07
|
| Rate for Payer: Mercy Care Medicaid |
$6,450.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,450.07
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$3,573.63
|
|
|
Service Code
|
APR-DRG 5391
|
| Hospital Charge Code |
APRDRG5392
|
| Min. Negotiated Rate |
$3,573.63 |
| Max. Negotiated Rate |
$3,573.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,573.63
|
| Rate for Payer: Mercy Care Medicaid |
$3,573.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,573.63
|
|
|
Cesarean Section With Sterilization
|
Facility
|
IP
|
$16,231.80
|
|
|
Service Code
|
APR-DRG 5394
|
| Hospital Charge Code |
APRDRG5393
|
| Min. Negotiated Rate |
$16,231.80 |
| Max. Negotiated Rate |
$16,231.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,231.80
|
| Rate for Payer: Mercy Care Medicaid |
$16,231.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,231.80
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$13,788.15
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$13,788.15 |
| Max. Negotiated Rate |
$13,788.15 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,788.15
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$31,730.06
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$31,730.06 |
| Max. Negotiated Rate |
$31,730.06 |
| Rate for Payer: Seven Corners Travel Insurance |
$31,730.06
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$12,491.88
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$12,491.88 |
| Max. Negotiated Rate |
$12,491.88 |
| Rate for Payer: Seven Corners Travel Insurance |
$12,491.88
|
|
|
CHAIN OF CUST URINE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
22587919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$7.84
|
| Rate for Payer: Banner UC Health Medicare |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$7.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.37
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cigna of AZ Commercial |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$8.82
|
| Rate for Payer: Humana of AZ Medicare |
$7.84
|
| Rate for Payer: Southwest Service Administrators UFCW |
$33.32
|
| Rate for Payer: TriWest Medicare |
$7.84
|
| Rate for Payer: United Healthcare Commercial |
$28.03
|
| Rate for Payer: United Healthcare Medicare |
$7.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$7.76
|
|
|
CHAIN OF CUST URINE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
22587919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of AZ Commercial |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
|
|
charcoal 25 g Oral Susp 120 mL [CQCH]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 574012174
|
| Hospital Charge Code |
105915987
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| 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 |
$0.09
|
| 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
|
|
|
charcoal 25 g Oral Susp 120 mL [CQCH]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 574012174
|
| Hospital Charge Code |
105915987
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of AZ Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
|
|
charcoal-sorbitol 25 g Oral Susp 120 mL [CQCH]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 66689020304
|
| Hospital Charge Code |
105916052
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of AZ Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
|
