|
COOLSEAL REVEAL
|
Facility
|
IP
|
$2,575.00
|
|
| Hospital Charge Code |
29572944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,317.50 |
| Max. Negotiated Rate |
$2,317.50 |
| Rate for Payer: Aetna of AZ Commercial |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,060.00
|
|
|
Copper Serum LC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1285554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$34.56
|
| Rate for Payer: Arizona Complete Health Allwell |
$23.68
|
| Rate for Payer: Banner UC Health Medicare |
$34.56
|
| Rate for Payer: Banner UC Health Medicare |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$146.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$34.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$23.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$34.56
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna of AZ Commercial |
$140.40
|
| Rate for Payer: Cigna of AZ Commercial |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$38.88
|
| Rate for Payer: Devoted Health Medicare |
$26.64
|
| Rate for Payer: Humana of AZ Medicare |
$23.68
|
| Rate for Payer: Humana of AZ Medicare |
$34.56
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.99
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.99
|
| Rate for Payer: Southwest Service Administrators UFCW |
$146.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$100.64
|
| Rate for Payer: TriWest Medicare |
$23.68
|
| Rate for Payer: TriWest Medicare |
$34.56
|
| Rate for Payer: United Healthcare Commercial |
$84.66
|
| Rate for Payer: United Healthcare Commercial |
$123.55
|
| Rate for Payer: United Healthcare Medicare |
$23.68
|
| Rate for Payer: United Healthcare Medicare |
$34.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$34.21
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.44
|
|
|
Copper Serum LC
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
1285554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of AZ Commercial |
$194.40
|
| Rate for Payer: Aetna of AZ Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$118.40
|
|
|
Copper, Urine LC
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2029250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.96
|
| Rate for Payer: Banner UC Health Medicare |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$106.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.96
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna of AZ Commercial |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$28.08
|
| Rate for Payer: Humana of AZ Medicare |
$24.96
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.99
|
| Rate for Payer: Southwest Service Administrators UFCW |
$106.08
|
| Rate for Payer: TriWest Medicare |
$24.96
|
| Rate for Payer: United Healthcare Commercial |
$89.23
|
| Rate for Payer: United Healthcare Medicare |
$24.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.71
|
|
|
Copper, Urine LC
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2029250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of AZ Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
|
|
Cord Gas Venous 1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
5144987
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$51.36
|
| Rate for Payer: Banner UC Health Medicare |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$51.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$51.36
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cigna of AZ Commercial |
$208.65
|
| Rate for Payer: Devoted Health Medicare |
$57.78
|
| Rate for Payer: Humana of AZ Medicare |
$51.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$37.80
|
| Rate for Payer: Southwest Service Administrators UFCW |
$218.28
|
| Rate for Payer: TriWest Medicare |
$51.36
|
| Rate for Payer: United Healthcare Commercial |
$183.61
|
| Rate for Payer: United Healthcare Medicare |
$51.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$50.85
|
|
|
Cord Gas Venous 1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
5144987
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna of AZ Commercial |
$288.90
|
| Rate for Payer: Cash Price |
$256.80
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$50,697.89
|
|
|
Service Code
|
APR-DRG 1654
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$50,697.89 |
| Max. Negotiated Rate |
$50,697.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,697.89
|
| Rate for Payer: Mercy Care Medicaid |
$50,697.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,697.89
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$34,605.67
|
|
|
Service Code
|
APR-DRG 1653
|
| Hospital Charge Code |
APRDRG1651
|
| Min. Negotiated Rate |
$34,605.67 |
| Max. Negotiated Rate |
$34,605.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$34,605.67
|
| Rate for Payer: Mercy Care Medicaid |
$34,605.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$34,605.67
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$27,271.13
|
|
|
Service Code
|
APR-DRG 1652
|
| Hospital Charge Code |
APRDRG1653
|
| Min. Negotiated Rate |
$27,271.13 |
| Max. Negotiated Rate |
$27,271.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,271.13
|
| Rate for Payer: Mercy Care Medicaid |
$27,271.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,271.13
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1652
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,090.79
|
|
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$23,090.79
|
|
|
Service Code
|
APR-DRG 1651
|
| Hospital Charge Code |
APRDRG1654
|
| Min. Negotiated Rate |
$23,090.79 |
| Max. Negotiated Rate |
$23,090.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$23,090.79
|
| Rate for Payer: Mercy Care Medicaid |
$23,090.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$23,090.79
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$98,807.64
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$98,807.64 |
| Max. Negotiated Rate |
$98,807.64 |
| Rate for Payer: Seven Corners Travel Insurance |
$98,807.64
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$70,600.70
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$70,600.70 |
| Max. Negotiated Rate |
$70,600.70 |
| Rate for Payer: Seven Corners Travel Insurance |
$70,600.70
|
|
