|
fosphenytoin (PE) 500 mg/10 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
105923388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of AZ Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$1.13
|
|
|
fosphenytoin (PE) 500 mg/10 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
105923388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of AZ Commercial |
$1.27
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.23
|
| Rate for Payer: Banner UC Health Medicare |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.23
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.23
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cigna of AZ Commercial |
$0.92
|
| Rate for Payer: Devoted Health Medicare |
$0.25
|
| Rate for Payer: Humana of AZ Medicare |
$0.23
|
| Rate for Payer: Seven Corners Travel Insurance |
$0.97
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.96
|
| Rate for Payer: TriWest Medicare |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.22
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,836.66
|
|
|
Service Code
|
APR-DRG 3402
|
| Hospital Charge Code |
APRDRG3404
|
| Min. Negotiated Rate |
$3,836.66 |
| Max. Negotiated Rate |
$3,836.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,836.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,836.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,836.66
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$10,305.67
|
|
|
Service Code
|
APR-DRG 3404
|
| Hospital Charge Code |
APRDRG3403
|
| Min. Negotiated Rate |
$10,305.67 |
| Max. Negotiated Rate |
$10,305.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,305.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,305.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,305.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,143.67
|
|
|
Service Code
|
APR-DRG 3401
|
| Hospital Charge Code |
APRDRG3401
|
| Min. Negotiated Rate |
$3,143.67 |
| Max. Negotiated Rate |
$3,143.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,143.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,143.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,143.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,143.67
|
|
|
Service Code
|
APR-DRG 3401
|
| Hospital Charge Code |
APRDRG3404
|
| Min. Negotiated Rate |
$3,143.67 |
| Max. Negotiated Rate |
$3,143.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,143.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,143.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,143.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,143.67
|
|
|
Service Code
|
APR-DRG 3401
|
| Hospital Charge Code |
APRDRG3402
|
| Min. Negotiated Rate |
$3,143.67 |
| Max. Negotiated Rate |
$3,143.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,143.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,143.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,143.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,836.66
|
|
|
Service Code
|
APR-DRG 3402
|
| Hospital Charge Code |
APRDRG3402
|
| Min. Negotiated Rate |
$3,836.66 |
| Max. Negotiated Rate |
$3,836.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,836.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,836.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,836.66
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,836.66
|
|
|
Service Code
|
APR-DRG 3402
|
| Hospital Charge Code |
APRDRG3401
|
| Min. Negotiated Rate |
$3,836.66 |
| Max. Negotiated Rate |
$3,836.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,836.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,836.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,836.66
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$5,646.27
|
|
|
Service Code
|
APR-DRG 3403
|
| Hospital Charge Code |
APRDRG3403
|
| Min. Negotiated Rate |
$5,646.27 |
| Max. Negotiated Rate |
$5,646.27 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,646.27
|
| Rate for Payer: Mercy Care Medicaid |
$5,646.27
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,646.27
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,836.66
|
|
|
Service Code
|
APR-DRG 3402
|
| Hospital Charge Code |
APRDRG3403
|
| Min. Negotiated Rate |
$3,836.66 |
| Max. Negotiated Rate |
$3,836.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,836.66
|
| Rate for Payer: Mercy Care Medicaid |
$3,836.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,836.66
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$10,305.67
|
|
|
Service Code
|
APR-DRG 3404
|
| Hospital Charge Code |
APRDRG3401
|
| Min. Negotiated Rate |
$10,305.67 |
| Max. Negotiated Rate |
$10,305.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,305.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,305.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,305.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$5,646.27
|
|
|
Service Code
|
APR-DRG 3403
|
| Hospital Charge Code |
APRDRG3401
|
| Min. Negotiated Rate |
$5,646.27 |
| Max. Negotiated Rate |
$5,646.27 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,646.27
|
| Rate for Payer: Mercy Care Medicaid |
$5,646.27
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,646.27
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$3,143.67
|
|
|
Service Code
|
APR-DRG 3401
|
| Hospital Charge Code |
APRDRG3403
|
| Min. Negotiated Rate |
$3,143.67 |
| Max. Negotiated Rate |
$3,143.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,143.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,143.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,143.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$5,646.27
|
|
|
Service Code
|
APR-DRG 3403
|
| Hospital Charge Code |
APRDRG3402
|
| Min. Negotiated Rate |
$5,646.27 |
| Max. Negotiated Rate |
$5,646.27 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,646.27
|
| Rate for Payer: Mercy Care Medicaid |
$5,646.27
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,646.27
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$10,305.67
|
|
|
Service Code
|
APR-DRG 3404
|
| Hospital Charge Code |
APRDRG3404
|
| Min. Negotiated Rate |
$10,305.67 |
| Max. Negotiated Rate |
$10,305.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,305.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,305.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,305.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$10,305.67
|
|
|
Service Code
|
APR-DRG 3404
|
| Hospital Charge Code |
APRDRG3402
|
| Min. Negotiated Rate |
$10,305.67 |
| Max. Negotiated Rate |
$10,305.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,305.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,305.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,305.67
|
|
|
Fracture Of Femur
|
Facility
|
IP
|
$5,646.27
|
|
|
Service Code
|
APR-DRG 3403
|
| Hospital Charge Code |
APRDRG3404
|
| Min. Negotiated Rate |
$5,646.27 |
| Max. Negotiated Rate |
$5,646.27 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,646.27
|
| Rate for Payer: Mercy Care Medicaid |
$5,646.27
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,646.27
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$5,232.44
|
|
|
Service Code
|
APR-DRG 3413
|
| Hospital Charge Code |
APRDRG3413
|
| Min. Negotiated Rate |
$5,232.44 |
| Max. Negotiated Rate |
$5,232.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,232.44
|
| Rate for Payer: Mercy Care Medicaid |
$5,232.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,232.44
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$10,958.67
|
|
|
Service Code
|
APR-DRG 3414
|
| Hospital Charge Code |
APRDRG3412
|
| Min. Negotiated Rate |
$10,958.67 |
| Max. Negotiated Rate |
$10,958.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,958.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,958.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,958.67
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$5,232.44
|
|
|
Service Code
|
APR-DRG 3413
|
| Hospital Charge Code |
APRDRG3414
|
| Min. Negotiated Rate |
$5,232.44 |
| Max. Negotiated Rate |
$5,232.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,232.44
|
| Rate for Payer: Mercy Care Medicaid |
$5,232.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,232.44
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$3,255.90
|
|
|
Service Code
|
APR-DRG 3411
|
| Hospital Charge Code |
APRDRG3412
|
| Min. Negotiated Rate |
$3,255.90 |
| Max. Negotiated Rate |
$3,255.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,255.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,255.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,255.90
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$3,255.90
|
|
|
Service Code
|
APR-DRG 3411
|
| Hospital Charge Code |
APRDRG3414
|
| Min. Negotiated Rate |
$3,255.90 |
| Max. Negotiated Rate |
$3,255.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,255.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,255.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,255.90
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$10,958.67
|
|
|
Service Code
|
APR-DRG 3414
|
| Hospital Charge Code |
APRDRG3413
|
| Min. Negotiated Rate |
$10,958.67 |
| Max. Negotiated Rate |
$10,958.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,958.67
|
| Rate for Payer: Mercy Care Medicaid |
$10,958.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,958.67
|
|
|
Fracture Of Pelvis Or Dislocation Of Hip
|
Facility
|
IP
|
$3,255.90
|
|
|
Service Code
|
APR-DRG 3411
|
| Hospital Charge Code |
APRDRG3411
|
| Min. Negotiated Rate |
$3,255.90 |
| Max. Negotiated Rate |
$3,255.90 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,255.90
|
| Rate for Payer: Mercy Care Medicaid |
$3,255.90
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,255.90
|
|
