|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$8,202.87
|
|
|
Service Code
|
APR-DRG 0423
|
| Hospital Charge Code |
APRDRG0423
|
| Min. Negotiated Rate |
$8,202.87 |
| Max. Negotiated Rate |
$8,202.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,202.87
|
| Rate for Payer: Mercy Care Medicaid |
$8,202.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,202.87
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$4,510.70
|
|
|
Service Code
|
APR-DRG 0421
|
| Hospital Charge Code |
APRDRG0421
|
| Min. Negotiated Rate |
$4,510.70 |
| Max. Negotiated Rate |
$4,510.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,510.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,510.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,510.70
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$8,202.87
|
|
|
Service Code
|
APR-DRG 0423
|
| Hospital Charge Code |
APRDRG0424
|
| Min. Negotiated Rate |
$8,202.87 |
| Max. Negotiated Rate |
$8,202.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,202.87
|
| Rate for Payer: Mercy Care Medicaid |
$8,202.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,202.87
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$5,412.00
|
|
|
Service Code
|
APR-DRG 0422
|
| Hospital Charge Code |
APRDRG0422
|
| Min. Negotiated Rate |
$5,412.00 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,412.00
|
| Rate for Payer: Mercy Care Medicaid |
$5,412.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,412.00
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$4,510.70
|
|
|
Service Code
|
APR-DRG 0421
|
| Hospital Charge Code |
APRDRG0424
|
| Min. Negotiated Rate |
$4,510.70 |
| Max. Negotiated Rate |
$4,510.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,510.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,510.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,510.70
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$17,275.48
|
|
|
Service Code
|
APR-DRG 0424
|
| Hospital Charge Code |
APRDRG0422
|
| Min. Negotiated Rate |
$17,275.48 |
| Max. Negotiated Rate |
$17,275.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,275.48
|
| Rate for Payer: Mercy Care Medicaid |
$17,275.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,275.48
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$17,275.48
|
|
|
Service Code
|
APR-DRG 0424
|
| Hospital Charge Code |
APRDRG0423
|
| Min. Negotiated Rate |
$17,275.48 |
| Max. Negotiated Rate |
$17,275.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,275.48
|
| Rate for Payer: Mercy Care Medicaid |
$17,275.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,275.48
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$5,412.00
|
|
|
Service Code
|
APR-DRG 0422
|
| Hospital Charge Code |
APRDRG0424
|
| Min. Negotiated Rate |
$5,412.00 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,412.00
|
| Rate for Payer: Mercy Care Medicaid |
$5,412.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,412.00
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$4,510.70
|
|
|
Service Code
|
APR-DRG 0421
|
| Hospital Charge Code |
APRDRG0423
|
| Min. Negotiated Rate |
$4,510.70 |
| Max. Negotiated Rate |
$4,510.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,510.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,510.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,510.70
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$8,202.87
|
|
|
Service Code
|
APR-DRG 0423
|
| Hospital Charge Code |
APRDRG0422
|
| Min. Negotiated Rate |
$8,202.87 |
| Max. Negotiated Rate |
$8,202.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,202.87
|
| Rate for Payer: Mercy Care Medicaid |
$8,202.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,202.87
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$5,412.00
|
|
|
Service Code
|
APR-DRG 0422
|
| Hospital Charge Code |
APRDRG0423
|
| Min. Negotiated Rate |
$5,412.00 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,412.00
|
| Rate for Payer: Mercy Care Medicaid |
$5,412.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,412.00
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$17,275.48
|
|
|
Service Code
|
APR-DRG 0424
|
| Hospital Charge Code |
APRDRG0424
|
| Min. Negotiated Rate |
$17,275.48 |
| Max. Negotiated Rate |
$17,275.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,275.48
|
| Rate for Payer: Mercy Care Medicaid |
$17,275.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,275.48
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$17,275.48
|
|
|
Service Code
|
APR-DRG 0424
|
| Hospital Charge Code |
APRDRG0421
|
| Min. Negotiated Rate |
$17,275.48 |
| Max. Negotiated Rate |
$17,275.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,275.48
|
| Rate for Payer: Mercy Care Medicaid |
$17,275.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,275.48
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$8,202.87
|
|
|
Service Code
|
APR-DRG 0423
|
| Hospital Charge Code |
APRDRG0421
|
| Min. Negotiated Rate |
$8,202.87 |
| Max. Negotiated Rate |
$8,202.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,202.87
|
| Rate for Payer: Mercy Care Medicaid |
$8,202.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,202.87
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$5,412.00
|
|
|
Service Code
|
APR-DRG 0422
|
| Hospital Charge Code |
APRDRG0421
|
| Min. Negotiated Rate |
$5,412.00 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,412.00
|
| Rate for Payer: Mercy Care Medicaid |
$5,412.00
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,412.00
|
|
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
Facility
|
IP
|
$4,510.70
|
|
|
Service Code
|
APR-DRG 0421
|
| Hospital Charge Code |
APRDRG0422
|
| Min. Negotiated Rate |
$4,510.70 |
| Max. Negotiated Rate |
$4,510.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,510.70
|
| Rate for Payer: Mercy Care Medicaid |
$4,510.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,510.70
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$30,024.06
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$30,024.06 |
| Max. Negotiated Rate |
$30,024.06 |
| Rate for Payer: Seven Corners Travel Insurance |
$30,024.06
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$16,772.21
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$16,772.21 |
| Max. Negotiated Rate |
$16,772.21 |
| Rate for Payer: Seven Corners Travel Insurance |
$16,772.21
|
|
|
Dehydroepiandrosterone (DHEA) LC
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
1906831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna of AZ Commercial |
$716.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$127.36
|
| Rate for Payer: Banner UC Health Medicare |
$127.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$541.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$127.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$127.36
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cigna of AZ Commercial |
$517.40
|
| Rate for Payer: Devoted Health Medicare |
$143.28
|
| Rate for Payer: Humana of AZ Medicare |
$127.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$36.64
|
| Rate for Payer: Southwest Service Administrators UFCW |
$541.28
|
| Rate for Payer: TriWest Medicare |
$127.36
|
| Rate for Payer: United Healthcare Commercial |
$455.31
|
| Rate for Payer: United Healthcare Medicare |
$127.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$126.09
|
|
|
Dehydroepiandrosterone (DHEA) LC
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
1906831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$716.40 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna of AZ Commercial |
$716.40
|
| Rate for Payer: Cash Price |
$636.80
|
|
|
Dehydroepiandrosterone Sulfate LC
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
1906835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of AZ Commercial |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
|
|
Dehydroepiandrosterone Sulfate LC
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
1906835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of AZ Commercial |
$413.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$73.44
|
| Rate for Payer: Banner UC Health Medicare |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$312.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$73.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$73.44
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna of AZ Commercial |
$298.35
|
| Rate for Payer: Devoted Health Medicare |
$82.62
|
| Rate for Payer: Humana of AZ Medicare |
$73.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$32.23
|
| Rate for Payer: Southwest Service Administrators UFCW |
$312.12
|
| Rate for Payer: TriWest Medicare |
$73.44
|
| Rate for Payer: United Healthcare Commercial |
$262.55
|
| Rate for Payer: United Healthcare Medicare |
$73.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$72.71
|
|
|
DELUXE PNEUMATIC LEG WALKER L
|
Facility
|
IP
|
$235.17
|
|
| Hospital Charge Code |
28054648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.65 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Aetna of AZ Commercial |
$211.65
|
| Rate for Payer: Cash Price |
$188.14
|
|
|
DELUXE PNEUMATIC LEG WALKER L
|
Facility
|
OP
|
$235.17
|
|
| Hospital Charge Code |
28054648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Aetna of AZ Commercial |
$211.65
|
| Rate for Payer: Arizona Complete Health Allwell |
$37.63
|
| Rate for Payer: Banner UC Health Medicare |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$159.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$37.63
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$37.63
|
| Rate for Payer: Cash Price |
$188.14
|
| Rate for Payer: Cigna of AZ Commercial |
$164.62
|
| Rate for Payer: Devoted Health Medicare |
$42.33
|
| Rate for Payer: Humana of AZ Medicare |
$37.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$159.92
|
| Rate for Payer: TriWest Medicare |
$37.63
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
| Rate for Payer: United Healthcare Medicare |
$37.63
|
| Rate for Payer: Veterans Affairs TRICARE |
$37.25
|
|
|
DELUXE PNEUMATIC LEG WALKER M
|
Facility
|
OP
|
$228.10
|
|
| Hospital Charge Code |
28054650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$205.29 |
| Rate for Payer: Aetna of AZ Commercial |
$205.29
|
| Rate for Payer: Arizona Complete Health Allwell |
$36.50
|
| Rate for Payer: Banner UC Health Medicare |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$155.11
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$36.50
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$36.50
|
| Rate for Payer: Cash Price |
$182.48
|
| Rate for Payer: Cigna of AZ Commercial |
$159.67
|
| Rate for Payer: Devoted Health Medicare |
$41.06
|
| Rate for Payer: Humana of AZ Medicare |
$36.50
|
| Rate for Payer: Southwest Service Administrators UFCW |
$155.11
|
| Rate for Payer: TriWest Medicare |
$36.50
|
| Rate for Payer: United Healthcare Commercial |
$130.47
|
| Rate for Payer: United Healthcare Medicare |
$36.50
|
| Rate for Payer: Veterans Affairs TRICARE |
$36.13
|
|
