|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$10,499.99
|
|
|
Service Code
|
MSDRG 382
|
| Min. Negotiated Rate |
$10,499.99 |
| Max. Negotiated Rate |
$10,499.99 |
| Rate for Payer: Seven Corners Travel Insurance |
$10,499.99
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$13,055.77
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$13,055.77 |
| Max. Negotiated Rate |
$13,055.77 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,055.77
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$23,661.52
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$23,661.52 |
| Max. Negotiated Rate |
$23,661.52 |
| Rate for Payer: Seven Corners Travel Insurance |
$23,661.52
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$9,078.29
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$9,078.29 |
| Max. Negotiated Rate |
$9,078.29 |
| Rate for Payer: Seven Corners Travel Insurance |
$9,078.29
|
|
|
Comprehensive Metabolic Panel Standard
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
22141044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of AZ Commercial |
$351.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$62.40
|
| Rate for Payer: Banner UC Health Medicare |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$62.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$62.40
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna of AZ Commercial |
$253.50
|
| Rate for Payer: Devoted Health Medicare |
$70.20
|
| Rate for Payer: Humana of AZ Medicare |
$62.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$15.31
|
| Rate for Payer: Southwest Service Administrators UFCW |
$265.20
|
| Rate for Payer: TriWest Medicare |
$62.40
|
| Rate for Payer: United Healthcare Commercial |
$223.08
|
| Rate for Payer: United Healthcare Medicare |
$62.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$61.78
|
|
|
Comprehensive Metabolic Panel Standard
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
22141044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of AZ Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$312.00
|
|
|
Computer Crossmatch
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1779651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$28.32
|
| Rate for Payer: Banner UC Health Medicare |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$120.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$28.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$28.32
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Devoted Health Medicare |
$31.86
|
| Rate for Payer: Humana of AZ Medicare |
$28.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$263.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$120.36
|
| Rate for Payer: TriWest Medicare |
$28.32
|
| Rate for Payer: United Healthcare Commercial |
$101.24
|
| Rate for Payer: United Healthcare Medicare |
$28.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$28.04
|
|
|
Computer Crossmatch
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1681859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
|
|
Computer Crossmatch
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1779651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
|
|
Computer Crossmatch
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
1681859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$263.61 |
| Rate for Payer: Aetna of AZ Commercial |
$159.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$28.32
|
| Rate for Payer: Banner UC Health Medicare |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$120.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$28.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$28.32
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna of AZ Commercial |
$115.05
|
| Rate for Payer: Devoted Health Medicare |
$31.86
|
| Rate for Payer: Humana of AZ Medicare |
$28.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$263.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$120.36
|
| Rate for Payer: TriWest Medicare |
$28.32
|
| Rate for Payer: United Healthcare Commercial |
$101.24
|
| Rate for Payer: United Healthcare Medicare |
$28.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$28.04
|
|
|
CONCENTRATION INFECT AGENT
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
22422557
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$7.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.96
|
| Rate for Payer: Banner UC Health Medicare |
$7.20
|
| Rate for Payer: Banner UC Health Medicare |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$7.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.96
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.65
|
| Rate for Payer: Cigna of AZ Commercial |
$29.25
|
| Rate for Payer: Devoted Health Medicare |
$14.58
|
| Rate for Payer: Devoted Health Medicare |
$8.10
|
| Rate for Payer: Humana of AZ Medicare |
$7.20
|
| Rate for Payer: Humana of AZ Medicare |
$12.96
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.69
|
| Rate for Payer: Seven Corners Travel Insurance |
$9.69
|
| Rate for Payer: Southwest Service Administrators UFCW |
$30.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$55.08
|
| Rate for Payer: TriWest Medicare |
$7.20
|
| Rate for Payer: TriWest Medicare |
$12.96
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
| Rate for Payer: United Healthcare Commercial |
$25.74
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
| Rate for Payer: United Healthcare Medicare |
$12.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.83
|
| Rate for Payer: Veterans Affairs TRICARE |
$7.13
|
|
|
CONCENTRATION INFECT AGENT
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
22422557
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of AZ Commercial |
$40.50
|
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$64.80
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$140,538.41
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$140,538.41 |
| Max. Negotiated Rate |
$140,538.41 |
| Rate for Payer: Seven Corners Travel Insurance |
$140,538.41
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$86,417.26
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$86,417.26 |
| Max. Negotiated Rate |
$86,417.26 |
| Rate for Payer: Seven Corners Travel Insurance |
$86,417.26
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$16,195.33
|
|
|
Service Code
|
APR-DRG 0574
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$16,195.33 |
| Max. Negotiated Rate |
$16,195.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,195.33
|
| Rate for Payer: Mercy Care Medicaid |
$16,195.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,195.33
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$16,195.33
|
|
|
Service Code
|
APR-DRG 0574
|
| Hospital Charge Code |
APRDRG0571
|
| Min. Negotiated Rate |
$16,195.33 |
| Max. Negotiated Rate |
$16,195.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,195.33
|
| Rate for Payer: Mercy Care Medicaid |
$16,195.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,195.33
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,008.19
|
|
|
Service Code
|
APR-DRG 0572
|
| Hospital Charge Code |
APRDRG0571
|
| Min. Negotiated Rate |
$6,008.19 |
| Max. Negotiated Rate |
$6,008.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,008.19
|
| Rate for Payer: Mercy Care Medicaid |
$6,008.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,008.19
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,350.78
|
|
|
Service Code
|
APR-DRG 0571
|
| Hospital Charge Code |
APRDRG0571
|
| Min. Negotiated Rate |
$4,350.78 |
| Max. Negotiated Rate |
$4,350.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,350.78
|
| Rate for Payer: Mercy Care Medicaid |
$4,350.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,350.78
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$16,195.33
|
|
|
Service Code
|
APR-DRG 0574
|
| Hospital Charge Code |
APRDRG0572
|
| Min. Negotiated Rate |
$16,195.33 |
| Max. Negotiated Rate |
$16,195.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,195.33
|
| Rate for Payer: Mercy Care Medicaid |
$16,195.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,195.33
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$8,392.25
|
|
|
Service Code
|
APR-DRG 0573
|
| Hospital Charge Code |
APRDRG0571
|
| Min. Negotiated Rate |
$8,392.25 |
| Max. Negotiated Rate |
$8,392.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,392.25
|
| Rate for Payer: Mercy Care Medicaid |
$8,392.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,392.25
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$16,195.33
|
|
|
Service Code
|
APR-DRG 0574
|
| Hospital Charge Code |
APRDRG0573
|
| Min. Negotiated Rate |
$16,195.33 |
| Max. Negotiated Rate |
$16,195.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,195.33
|
| Rate for Payer: Mercy Care Medicaid |
$16,195.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,195.33
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,350.78
|
|
|
Service Code
|
APR-DRG 0571
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$4,350.78 |
| Max. Negotiated Rate |
$4,350.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,350.78
|
| Rate for Payer: Mercy Care Medicaid |
$4,350.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,350.78
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$4,350.78
|
|
|
Service Code
|
APR-DRG 0571
|
| Hospital Charge Code |
APRDRG0572
|
| Min. Negotiated Rate |
$4,350.78 |
| Max. Negotiated Rate |
$4,350.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,350.78
|
| Rate for Payer: Mercy Care Medicaid |
$4,350.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,350.78
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$8,392.25
|
|
|
Service Code
|
APR-DRG 0573
|
| Hospital Charge Code |
APRDRG0574
|
| Min. Negotiated Rate |
$8,392.25 |
| Max. Negotiated Rate |
$8,392.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,392.25
|
| Rate for Payer: Mercy Care Medicaid |
$8,392.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,392.25
|
|
|
Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma
|
Facility
|
IP
|
$6,008.19
|
|
|
Service Code
|
APR-DRG 0572
|
| Hospital Charge Code |
APRDRG0573
|
| Min. Negotiated Rate |
$6,008.19 |
| Max. Negotiated Rate |
$6,008.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,008.19
|
| Rate for Payer: Mercy Care Medicaid |
$6,008.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,008.19
|
|
