|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$16,038.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$16,038.21 |
| Max. Negotiated Rate |
$16,038.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,038.21
|
| Rate for Payer: Mercy Care Medicaid |
$16,038.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,038.21
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$16,038.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$16,038.21 |
| Max. Negotiated Rate |
$16,038.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,038.21
|
| Rate for Payer: Mercy Care Medicaid |
$16,038.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,038.21
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$6,159.69
|
|
|
Service Code
|
APR-DRG 0452
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$6,159.69 |
| Max. Negotiated Rate |
$6,159.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,159.69
|
| Rate for Payer: Mercy Care Medicaid |
$6,159.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,159.69
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,900.68
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0452
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$16,038.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Hospital Charge Code |
APRDRG0451
|
| Min. Negotiated Rate |
$16,038.21 |
| Max. Negotiated Rate |
$16,038.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,038.21
|
| Rate for Payer: Mercy Care Medicaid |
$16,038.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,038.21
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$8,899.36
|
|
|
Service Code
|
APR-DRG 0453
|
| Hospital Charge Code |
APRDRG0454
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$8,899.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,899.36
|
| Rate for Payer: Mercy Care Medicaid |
$8,899.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,899.36
|
|
|
Cva And Precerebral Occlusion With Infarction
|
Facility
|
IP
|
$4,900.68
|
|
|
Service Code
|
APR-DRG 0451
|
| Hospital Charge Code |
APRDRG0453
|
| Min. Negotiated Rate |
$4,900.68 |
| Max. Negotiated Rate |
$4,900.68 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,900.68
|
| Rate for Payer: Mercy Care Medicaid |
$4,900.68
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,900.68
|
|
|
cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
105917587
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.34
|
| Rate for Payer: Banner UC Health Medicare |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.34
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.34
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna of AZ Commercial |
$1.38
|
| Rate for Payer: Devoted Health Medicare |
$0.38
|
| Rate for Payer: Humana of AZ Medicare |
$0.34
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1.45
|
| Rate for Payer: TriWest Medicare |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.34
|
|
|
cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
105917587
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of AZ Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.70
|
|
|
cyclopentolate Ophth 1% Sol [CQCH]
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
105917736
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna of AZ Commercial |
$23.41
|
| Rate for Payer: Arizona Complete Health Allwell |
$4.16
|
| Rate for Payer: Banner UC Health Medicare |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$17.69
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$4.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$4.16
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of AZ Commercial |
$16.91
|
| Rate for Payer: Devoted Health Medicare |
$4.68
|
| Rate for Payer: Humana of AZ Medicare |
$4.16
|
| Rate for Payer: Southwest Service Administrators UFCW |
$17.69
|
| Rate for Payer: TriWest Medicare |
$4.16
|
| Rate for Payer: United Healthcare Commercial |
$14.88
|
| Rate for Payer: United Healthcare Medicare |
$4.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$4.12
|
|
|
cyclopentolate Ophth 1% Sol [CQCH]
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
105917736
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna of AZ Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$20.81
|
|
|
Cyclosporine, Blood LC
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
1285593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna of AZ Commercial |
$265.50
|
| Rate for Payer: Cash Price |
$236.00
|
|
|
Cyclosporine, Blood LC
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
1285593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna of AZ Commercial |
$265.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$47.20
|
| Rate for Payer: Banner UC Health Medicare |
$47.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$47.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna of AZ Commercial |
$191.75
|
| Rate for Payer: Devoted Health Medicare |
$53.10
|
| Rate for Payer: Humana of AZ Medicare |
$47.20
|
| Rate for Payer: Seven Corners Travel Insurance |
$26.17
|
| Rate for Payer: Southwest Service Administrators UFCW |
$200.60
|
| Rate for Payer: TriWest Medicare |
$47.20
|
| Rate for Payer: United Healthcare Commercial |
$168.74
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$46.73
|
|
|
CYGNUS DUAL 2X3
|
Facility
|
OP
|
$7,666.67
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27694663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,900.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,226.67
|
| Rate for Payer: Banner UC Health Medicare |
$1,226.67
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$5,213.34
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,226.67
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,226.67
|
| Rate for Payer: Cash Price |
$6,133.34
|
| Rate for Payer: Cash Price |
$6,133.34
|
| Rate for Payer: Cigna of AZ Commercial |
$5,366.67
|
| Rate for Payer: Devoted Health Medicare |
$1,380.00
|
| Rate for Payer: Humana of AZ Medicare |
$1,226.67
|
| Rate for Payer: Seven Corners Travel Insurance |
$192.55
|
| Rate for Payer: Southwest Service Administrators UFCW |
$5,213.34
|
| Rate for Payer: TriWest Medicare |
$1,226.67
|
| Rate for Payer: United Healthcare Commercial |
$4,385.34
|
| Rate for Payer: United Healthcare Medicare |
$1,226.67
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$1,456.67
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,214.40
|
|
|
CYGNUS DUAL 2X3
|
Facility
|
IP
|
$7,666.67
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27694663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,900.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,900.00
|
| Rate for Payer: Cash Price |
$6,133.34
|
|
|
CYGNUS DUAL 4X4
|
Facility
|
OP
|
$7,450.00
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27702637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$6,705.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,705.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,192.00
|
| Rate for Payer: Banner UC Health Medicare |
$1,192.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$5,066.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,192.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,192.00
|
| Rate for Payer: Cash Price |
$5,960.00
|
| Rate for Payer: Cash Price |
$5,960.00
|
| Rate for Payer: Cigna of AZ Commercial |
$5,215.00
|
| Rate for Payer: Devoted Health Medicare |
$1,341.00
|
| Rate for Payer: Humana of AZ Medicare |
$1,192.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$192.55
|
| Rate for Payer: Southwest Service Administrators UFCW |
$5,066.00
|
| Rate for Payer: TriWest Medicare |
$1,192.00
|
| Rate for Payer: United Healthcare Commercial |
$4,261.40
|
| Rate for Payer: United Healthcare Medicare |
$1,192.00
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$1,415.50
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,180.08
|
|
|
CYGNUS DUAL 4X4
|
Facility
|
IP
|
$7,450.00
|
|
|
Service Code
|
HCPCS Q4282
|
| Hospital Charge Code |
27702637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,705.00 |
| Max. Negotiated Rate |
$6,705.00 |
| Rate for Payer: Aetna of AZ Commercial |
$6,705.00
|
| Rate for Payer: Cash Price |
$5,960.00
|
|
