|
CQCH Echo Doppler
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
22427827
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$788.40 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Cash Price |
$700.80
|
|
|
CQCH Echo Doppler
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
22427827
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$138.76 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of AZ Commercial |
$788.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$140.16
|
| Rate for Payer: Banner UC Health Medicare |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$595.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$140.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$140.16
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna of AZ Commercial |
$613.20
|
| Rate for Payer: Devoted Health Medicare |
$157.68
|
| Rate for Payer: Humana of AZ Medicare |
$140.16
|
| Rate for Payer: Southwest Service Administrators UFCW |
$595.68
|
| Rate for Payer: TriWest Medicare |
$140.16
|
| Rate for Payer: United Healthcare Commercial |
$501.07
|
| Rate for Payer: United Healthcare Medicare |
$140.16
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$166.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$138.76
|
|
|
CQCH Isovue 300
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
22427819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$22.24
|
| Rate for Payer: Banner UC Health Medicare |
$22.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$22.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$22.24
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cigna of AZ Commercial |
$97.30
|
| Rate for Payer: Devoted Health Medicare |
$25.02
|
| Rate for Payer: Humana of AZ Medicare |
$22.24
|
| Rate for Payer: Southwest Service Administrators UFCW |
$94.52
|
| Rate for Payer: TriWest Medicare |
$22.24
|
| Rate for Payer: United Healthcare Commercial |
$79.51
|
| Rate for Payer: United Healthcare Medicare |
$22.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$22.02
|
|
|
CQCH Isovue 300
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
22427819
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
|
|
CQCH Isovue 370
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
22427821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$22.24
|
| Rate for Payer: Banner UC Health Medicare |
$22.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$94.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$22.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$22.24
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cigna of AZ Commercial |
$97.30
|
| Rate for Payer: Devoted Health Medicare |
$25.02
|
| Rate for Payer: Humana of AZ Medicare |
$22.24
|
| Rate for Payer: Southwest Service Administrators UFCW |
$94.52
|
| Rate for Payer: TriWest Medicare |
$22.24
|
| Rate for Payer: United Healthcare Commercial |
$79.51
|
| Rate for Payer: United Healthcare Medicare |
$22.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$22.02
|
|
|
CQCH Isovue 370
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
22427821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of AZ Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
|
|
CQCH Magnevist
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
22427823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$39.84
|
| Rate for Payer: Banner UC Health Medicare |
$39.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$169.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$39.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$39.84
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna of AZ Commercial |
$174.30
|
| Rate for Payer: Devoted Health Medicare |
$44.82
|
| Rate for Payer: Humana of AZ Medicare |
$39.84
|
| Rate for Payer: Southwest Service Administrators UFCW |
$169.32
|
| Rate for Payer: TriWest Medicare |
$39.84
|
| Rate for Payer: United Healthcare Commercial |
$142.43
|
| Rate for Payer: United Healthcare Medicare |
$39.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$39.44
|
|
|
CQCH Magnevist
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
22427823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.10 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Aetna of AZ Commercial |
$224.10
|
| Rate for Payer: Cash Price |
$199.20
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$20,734.19
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$20,734.19 |
| Max. Negotiated Rate |
$20,734.19 |
| Rate for Payer: Seven Corners Travel Insurance |
$20,734.19
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$13,416.86
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$13,416.86 |
| Max. Negotiated Rate |
$13,416.86 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,416.86
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$40,183.75
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$40,183.75 |
| Max. Negotiated Rate |
$40,183.75 |
| Rate for Payer: Seven Corners Travel Insurance |
$40,183.75
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$58,762.19
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$58,762.19 |
| Max. Negotiated Rate |
$58,762.19 |
| Rate for Payer: Seven Corners Travel Insurance |
$58,762.19
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,606.32
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$32,606.32 |
| Max. Negotiated Rate |
$32,606.32 |
| Rate for Payer: Seven Corners Travel Insurance |
$32,606.32
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$28,854.89
|
|
|
Service Code
|
APR-DRG 9103
|
| Hospital Charge Code |
APRDRG9102
|
| Min. Negotiated Rate |
$28,854.89 |
| Max. Negotiated Rate |
$28,854.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,854.89
|
| Rate for Payer: Mercy Care Medicaid |
$28,854.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,854.89
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9102
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,111.52
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,111.52
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$28,854.89
|
|
|
Service Code
|
APR-DRG 9103
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$28,854.89 |
| Max. Negotiated Rate |
$28,854.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,854.89
|
| Rate for Payer: Mercy Care Medicaid |
$28,854.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,854.89
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$28,854.89
|
|
|
Service Code
|
APR-DRG 9103
|
| Hospital Charge Code |
APRDRG9104
|
| Min. Negotiated Rate |
$28,854.89 |
| Max. Negotiated Rate |
$28,854.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,854.89
|
| Rate for Payer: Mercy Care Medicaid |
$28,854.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,854.89
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9102
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9104
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$50,111.52
|
|
|
Service Code
|
APR-DRG 9104
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$50,111.52 |
| Max. Negotiated Rate |
$50,111.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$50,111.52
|
| Rate for Payer: Mercy Care Medicaid |
$50,111.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$50,111.52
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$28,854.89
|
|
|
Service Code
|
APR-DRG 9103
|
| Hospital Charge Code |
APRDRG9103
|
| Min. Negotiated Rate |
$28,854.89 |
| Max. Negotiated Rate |
$28,854.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,854.89
|
| Rate for Payer: Mercy Care Medicaid |
$28,854.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,854.89
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9101
|
| Hospital Charge Code |
APRDRG9101
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,777.26
|
|
|
Craniotomy For Multiple Significant Trauma
|
Facility
|
IP
|
$22,777.26
|
|
|
Service Code
|
APR-DRG 9102
|
| Hospital Charge Code |
APRDRG9102
|
| Min. Negotiated Rate |
$22,777.26 |
| Max. Negotiated Rate |
$22,777.26 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,777.26
|
| Rate for Payer: Mercy Care Medicaid |
$22,777.26
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,777.26
|
|
