|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
|
Service Code
|
APR-DRG 1102
|
| Hospital Charge Code |
APRDRG1104
|
| Min. Negotiated Rate |
$5,968.21 |
| Max. Negotiated Rate |
$5,968.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,968.21
|
| Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,968.21
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
|
Service Code
|
APR-DRG 1101
|
| Hospital Charge Code |
APRDRG1103
|
| Min. Negotiated Rate |
$4,909.80 |
| Max. Negotiated Rate |
$4,909.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,909.80
|
| Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,909.80
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
|
Service Code
|
APR-DRG 1103
|
| Hospital Charge Code |
APRDRG1102
|
| Min. Negotiated Rate |
$9,130.12 |
| Max. Negotiated Rate |
$9,130.12 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,130.12
|
| Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,130.12
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
|
Service Code
|
APR-DRG 1102
|
| Hospital Charge Code |
APRDRG1101
|
| Min. Negotiated Rate |
$5,968.21 |
| Max. Negotiated Rate |
$5,968.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,968.21
|
| Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,968.21
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
|
Service Code
|
APR-DRG 1104
|
| Hospital Charge Code |
APRDRG1101
|
| Min. Negotiated Rate |
$15,546.53 |
| Max. Negotiated Rate |
$15,546.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,546.53
|
| Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,546.53
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
|
Service Code
|
APR-DRG 1102
|
| Hospital Charge Code |
APRDRG1102
|
| Min. Negotiated Rate |
$5,968.21 |
| Max. Negotiated Rate |
$5,968.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,968.21
|
| Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,968.21
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
|
Service Code
|
APR-DRG 1104
|
| Hospital Charge Code |
APRDRG1103
|
| Min. Negotiated Rate |
$15,546.53 |
| Max. Negotiated Rate |
$15,546.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,546.53
|
| Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,546.53
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
|
Service Code
|
APR-DRG 1101
|
| Hospital Charge Code |
APRDRG1104
|
| Min. Negotiated Rate |
$4,909.80 |
| Max. Negotiated Rate |
$4,909.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,909.80
|
| Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,909.80
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
|
Service Code
|
APR-DRG 1104
|
| Hospital Charge Code |
APRDRG1104
|
| Min. Negotiated Rate |
$15,546.53 |
| Max. Negotiated Rate |
$15,546.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,546.53
|
| Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,546.53
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$15,546.53
|
|
|
Service Code
|
APR-DRG 1104
|
| Hospital Charge Code |
APRDRG1102
|
| Min. Negotiated Rate |
$15,546.53 |
| Max. Negotiated Rate |
$15,546.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,546.53
|
| Rate for Payer: Mercy Care Medicaid |
$15,546.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,546.53
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$5,968.21
|
|
|
Service Code
|
APR-DRG 1102
|
| Hospital Charge Code |
APRDRG1103
|
| Min. Negotiated Rate |
$5,968.21 |
| Max. Negotiated Rate |
$5,968.21 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,968.21
|
| Rate for Payer: Mercy Care Medicaid |
$5,968.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,968.21
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$4,909.80
|
|
|
Service Code
|
APR-DRG 1101
|
| Hospital Charge Code |
APRDRG1102
|
| Min. Negotiated Rate |
$4,909.80 |
| Max. Negotiated Rate |
$4,909.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,909.80
|
| Rate for Payer: Mercy Care Medicaid |
$4,909.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,909.80
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
|
Service Code
|
APR-DRG 1103
|
| Hospital Charge Code |
APRDRG1101
|
| Min. Negotiated Rate |
$9,130.12 |
| Max. Negotiated Rate |
$9,130.12 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,130.12
|
| Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,130.12
|
|
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
Facility
|
IP
|
$9,130.12
|
|
|
Service Code
|
APR-DRG 1103
|
| Hospital Charge Code |
APRDRG1103
|
| Min. Negotiated Rate |
$9,130.12 |
| Max. Negotiated Rate |
$9,130.12 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,130.12
|
| Rate for Payer: Mercy Care Medicaid |
$9,130.12
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,130.12
|
|
|
EASY CLIP MONOCORTICAL FIXATION DEVICE 8X8X8
|
Facility
|
IP
|
$11,615.00
|
|
| Hospital Charge Code |
27887275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10,453.50 |
| Max. Negotiated Rate |
$10,453.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,453.50
|
| Rate for Payer: Cash Price |
$9,292.00
|
|
|
EASY CLIP MONOCORTICAL FIXATION DEVICE 8X8X8
|
Facility
|
OP
|
$11,615.00
|
|
| Hospital Charge Code |
27887275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,839.82 |
| Max. Negotiated Rate |
$10,453.50 |
| Rate for Payer: Aetna of AZ Commercial |
$10,453.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$1,858.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,858.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$7,898.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1,858.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1,858.40
|
| Rate for Payer: Cash Price |
$9,292.00
|
| Rate for Payer: Cigna of AZ Commercial |
$8,130.50
|
| Rate for Payer: Devoted Health Medicare |
$2,090.70
|
| Rate for Payer: Humana of AZ Medicare |
$1,858.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$7,898.20
|
| Rate for Payer: TriWest Medicare |
$1,858.40
|
| Rate for Payer: United Healthcare Commercial |
$6,643.78
|
| Rate for Payer: United Healthcare Medicare |
$1,858.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$1,839.82
|
|
|
Eating Disorders
|
Facility
|
IP
|
$8,143.96
|
|
|
Service Code
|
APR-DRG 7592
|
| Hospital Charge Code |
APRDRG7592
|
| Min. Negotiated Rate |
$8,143.96 |
| Max. Negotiated Rate |
$8,143.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,143.96
|
| Rate for Payer: Mercy Care Medicaid |
$8,143.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,143.96
|
|
|
Eating Disorders
|
Facility
|
IP
|
$8,143.96
|
|
|
Service Code
|
APR-DRG 7592
|
| Hospital Charge Code |
APRDRG7594
|
| Min. Negotiated Rate |
$8,143.96 |
| Max. Negotiated Rate |
$8,143.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,143.96
|
| Rate for Payer: Mercy Care Medicaid |
$8,143.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,143.96
|
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
|
Service Code
|
APR-DRG 7591
|
| Hospital Charge Code |
APRDRG7592
|
| Min. Negotiated Rate |
$7,972.81 |
| Max. Negotiated Rate |
$7,972.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,972.81
|
| Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,972.81
|
|
|
Eating Disorders
|
Facility
|
IP
|
$8,143.96
|
|
|
Service Code
|
APR-DRG 7592
|
| Hospital Charge Code |
APRDRG7591
|
| Min. Negotiated Rate |
$8,143.96 |
| Max. Negotiated Rate |
$8,143.96 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,143.96
|
| Rate for Payer: Mercy Care Medicaid |
$8,143.96
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,143.96
|
|
|
Eating Disorders
|
Facility
|
IP
|
$28,590.47
|
|
|
Service Code
|
APR-DRG 7594
|
| Hospital Charge Code |
APRDRG7591
|
| Min. Negotiated Rate |
$28,590.47 |
| Max. Negotiated Rate |
$28,590.47 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,590.47
|
| Rate for Payer: Mercy Care Medicaid |
$28,590.47
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,590.47
|
|
|
Eating Disorders
|
Facility
|
IP
|
$11,545.04
|
|
|
Service Code
|
APR-DRG 7593
|
| Hospital Charge Code |
APRDRG7592
|
| Min. Negotiated Rate |
$11,545.04 |
| Max. Negotiated Rate |
$11,545.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,545.04
|
| Rate for Payer: Mercy Care Medicaid |
$11,545.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,545.04
|
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
|
Service Code
|
APR-DRG 7591
|
| Hospital Charge Code |
APRDRG7594
|
| Min. Negotiated Rate |
$7,972.81 |
| Max. Negotiated Rate |
$7,972.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,972.81
|
| Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,972.81
|
|
|
Eating Disorders
|
Facility
|
IP
|
$11,545.04
|
|
|
Service Code
|
APR-DRG 7593
|
| Hospital Charge Code |
APRDRG7591
|
| Min. Negotiated Rate |
$11,545.04 |
| Max. Negotiated Rate |
$11,545.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,545.04
|
| Rate for Payer: Mercy Care Medicaid |
$11,545.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,545.04
|
|
|
Eating Disorders
|
Facility
|
IP
|
$7,972.81
|
|
|
Service Code
|
APR-DRG 7591
|
| Hospital Charge Code |
APRDRG7591
|
| Min. Negotiated Rate |
$7,972.81 |
| Max. Negotiated Rate |
$7,972.81 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,972.81
|
| Rate for Payer: Mercy Care Medicaid |
$7,972.81
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,972.81
|
|
