|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
Facility
|
IP
|
$47,588.59
|
|
|
Service Code
|
APR-DRG 3044
|
| Hospital Charge Code |
APRDRG3044
|
| Min. Negotiated Rate |
$47,588.59 |
| Max. Negotiated Rate |
$47,588.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$47,588.59
|
| Rate for Payer: Mercy Care Medicaid |
$47,588.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$47,588.59
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
| Rate for Payer: NaphCare Correctional Healthcare |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$51,028.95
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3034
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
| Rate for Payer: NaphCare Correctional Healthcare |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
| Rate for Payer: NaphCare Correctional Healthcare |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$27,633.76
|
|
|
Service Code
|
APR-DRG 3031
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$27,633.76 |
| Max. Negotiated Rate |
$27,633.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,633.76
|
| Rate for Payer: Mercy Care Medicaid |
$27,633.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,633.76
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$35,683.73
|
|
|
Service Code
|
APR-DRG 3032
|
| Hospital Charge Code |
APRDRG3033
|
| Min. Negotiated Rate |
$35,683.73 |
| Max. Negotiated Rate |
$35,683.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,683.73
|
| Rate for Payer: Mercy Care Medicaid |
$35,683.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,683.73
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$66,449.23
|
|
|
Service Code
|
APR-DRG 3034
|
| Hospital Charge Code |
APRDRG3032
|
| Min. Negotiated Rate |
$66,449.23 |
| Max. Negotiated Rate |
$66,449.23 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$66,449.23
|
| Rate for Payer: Mercy Care Medicaid |
$66,449.23
|
| Rate for Payer: NaphCare Correctional Healthcare |
$66,449.23
|
|
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
Facility
|
IP
|
$51,028.95
|
|
|
Service Code
|
APR-DRG 3033
|
| Hospital Charge Code |
APRDRG3031
|
| Min. Negotiated Rate |
$51,028.95 |
| Max. Negotiated Rate |
$51,028.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$51,028.95
|
| Rate for Payer: Mercy Care Medicaid |
$51,028.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$51,028.95
|
|
|
DOUBLE SWIVEL CLOSED SUCTION CATH W/ENDO TRACH TUBE 14FR
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
24157727
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of AZ Commercial |
$81.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$14.40
|
| Rate for Payer: Banner UC Health Medicare |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$14.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of AZ Commercial |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$16.20
|
| Rate for Payer: Humana of AZ Medicare |
$14.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$61.20
|
| Rate for Payer: TriWest Medicare |
$14.40
|
| Rate for Payer: United Healthcare Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$14.26
|
|
|
DOUBLE SWIVEL CLOSED SUCTION CATH W/ENDO TRACH TUBE 14FR
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
24157727
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of AZ Commercial |
$81.00
|
| Rate for Payer: Cash Price |
$72.00
|
|
|
doxazosin 2 mg Tab [CQCH]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 51079095820
|
| Hospital Charge Code |
105919979
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$2.59
|
|
|
doxazosin 2 mg Tab [CQCH]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 51079095820
|
| Hospital Charge Code |
105919979
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of AZ Commercial |
$2.92
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.52
|
| Rate for Payer: Banner UC Health Medicare |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.52
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.11
|
| Rate for Payer: Devoted Health Medicare |
$0.58
|
| Rate for Payer: Humana of AZ Medicare |
$0.52
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2.20
|
| Rate for Payer: TriWest Medicare |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$1.85
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.51
|
|
|
doxepin 25 mg Cap [CQCH]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
105920044
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of AZ Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
|
|
doxepin 25 mg Cap [CQCH]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
105920044
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of AZ Commercial |
$0.33
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.06
|
| Rate for Payer: Banner UC Health Medicare |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.06
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of AZ Commercial |
$0.24
|
| Rate for Payer: Devoted Health Medicare |
$0.07
|
| Rate for Payer: Humana of AZ Medicare |
$0.06
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.25
|
| Rate for Payer: TriWest Medicare |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.21
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.06
|
|
|
doxycycline 100 mg IV Inj [CQCH]
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
NDC 63323013017
|
| Hospital Charge Code |
105920170
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna of AZ Commercial |
$15.49
|
| Rate for Payer: Cash Price |
$13.77
|
|
|
doxycycline 100 mg IV Inj [CQCH]
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
NDC 63323013017
|
| Hospital Charge Code |
105920170
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna of AZ Commercial |
$15.49
|
| Rate for Payer: Arizona Complete Health Allwell |
$2.75
|
| Rate for Payer: Banner UC Health Medicare |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$2.75
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$2.75
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cigna of AZ Commercial |
$11.19
|
| Rate for Payer: Devoted Health Medicare |
$3.10
|
| Rate for Payer: Humana of AZ Medicare |
$2.75
|
| Rate for Payer: Southwest Service Administrators UFCW |
$11.70
|
| Rate for Payer: TriWest Medicare |
$2.75
|
| Rate for Payer: United Healthcare Commercial |
$9.84
|
| Rate for Payer: United Healthcare Medicare |
$2.75
|
| Rate for Payer: Veterans Affairs TRICARE |
$2.73
|
|
