|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$21,407.43
|
|
|
Service Code
|
APR-DRG 1763
|
| Hospital Charge Code |
APRDRG1763
|
| Min. Negotiated Rate |
$21,407.43 |
| Max. Negotiated Rate |
$21,407.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,407.43
|
| Rate for Payer: Mercy Care Medicaid |
$21,407.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,407.43
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$21,407.43
|
|
|
Service Code
|
APR-DRG 1763
|
| Hospital Charge Code |
APRDRG1764
|
| Min. Negotiated Rate |
$21,407.43 |
| Max. Negotiated Rate |
$21,407.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,407.43
|
| Rate for Payer: Mercy Care Medicaid |
$21,407.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,407.43
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$11,330.42
|
|
|
Service Code
|
APR-DRG 1761
|
| Hospital Charge Code |
APRDRG1764
|
| Min. Negotiated Rate |
$11,330.42 |
| Max. Negotiated Rate |
$11,330.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,330.42
|
| Rate for Payer: Mercy Care Medicaid |
$11,330.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,330.42
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$36,653.06
|
|
|
Service Code
|
APR-DRG 1764
|
| Hospital Charge Code |
APRDRG1761
|
| Min. Negotiated Rate |
$36,653.06 |
| Max. Negotiated Rate |
$36,653.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$36,653.06
|
| Rate for Payer: Mercy Care Medicaid |
$36,653.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$36,653.06
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$21,407.43
|
|
|
Service Code
|
APR-DRG 1763
|
| Hospital Charge Code |
APRDRG1762
|
| Min. Negotiated Rate |
$21,407.43 |
| Max. Negotiated Rate |
$21,407.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,407.43
|
| Rate for Payer: Mercy Care Medicaid |
$21,407.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,407.43
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$36,653.06
|
|
|
Service Code
|
APR-DRG 1764
|
| Hospital Charge Code |
APRDRG1762
|
| Min. Negotiated Rate |
$36,653.06 |
| Max. Negotiated Rate |
$36,653.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$36,653.06
|
| Rate for Payer: Mercy Care Medicaid |
$36,653.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$36,653.06
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$13,891.93
|
|
|
Service Code
|
APR-DRG 1762
|
| Hospital Charge Code |
APRDRG1763
|
| Min. Negotiated Rate |
$13,891.93 |
| Max. Negotiated Rate |
$13,891.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,891.93
|
| Rate for Payer: Mercy Care Medicaid |
$13,891.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,891.93
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$11,330.42
|
|
|
Service Code
|
APR-DRG 1761
|
| Hospital Charge Code |
APRDRG1761
|
| Min. Negotiated Rate |
$11,330.42 |
| Max. Negotiated Rate |
$11,330.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,330.42
|
| Rate for Payer: Mercy Care Medicaid |
$11,330.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,330.42
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$13,891.93
|
|
|
Service Code
|
APR-DRG 1762
|
| Hospital Charge Code |
APRDRG1761
|
| Min. Negotiated Rate |
$13,891.93 |
| Max. Negotiated Rate |
$13,891.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,891.93
|
| Rate for Payer: Mercy Care Medicaid |
$13,891.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,891.93
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$36,653.06
|
|
|
Service Code
|
APR-DRG 1764
|
| Hospital Charge Code |
APRDRG1764
|
| Min. Negotiated Rate |
$36,653.06 |
| Max. Negotiated Rate |
$36,653.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$36,653.06
|
| Rate for Payer: Mercy Care Medicaid |
$36,653.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$36,653.06
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$13,891.93
|
|
|
Service Code
|
APR-DRG 1762
|
| Hospital Charge Code |
APRDRG1762
|
| Min. Negotiated Rate |
$13,891.93 |
| Max. Negotiated Rate |
$13,891.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,891.93
|
| Rate for Payer: Mercy Care Medicaid |
$13,891.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,891.93
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$13,891.93
|
|
|
Service Code
|
APR-DRG 1762
|
| Hospital Charge Code |
APRDRG1764
|
| Min. Negotiated Rate |
$13,891.93 |
| Max. Negotiated Rate |
$13,891.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,891.93
|
| Rate for Payer: Mercy Care Medicaid |
$13,891.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,891.93
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$11,330.42
|
|
|
Service Code
|
APR-DRG 1761
|
| Hospital Charge Code |
APRDRG1762
|
| Min. Negotiated Rate |
$11,330.42 |
| Max. Negotiated Rate |
$11,330.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,330.42
|
| Rate for Payer: Mercy Care Medicaid |
$11,330.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,330.42
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$21,407.43
|
|
|
Service Code
|
APR-DRG 1763
|
| Hospital Charge Code |
APRDRG1761
|
| Min. Negotiated Rate |
$21,407.43 |
| Max. Negotiated Rate |
$21,407.43 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$21,407.43
|
| Rate for Payer: Mercy Care Medicaid |
$21,407.43
|
| Rate for Payer: NaphCare Correctional Healthcare |
$21,407.43
|
|
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
Facility
|
IP
|
$11,330.42
|
|
|
Service Code
|
APR-DRG 1761
|
| Hospital Charge Code |
APRDRG1763
|
| Min. Negotiated Rate |
$11,330.42 |
| Max. Negotiated Rate |
$11,330.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,330.42
|
| Rate for Payer: Mercy Care Medicaid |
$11,330.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,330.42
|
|
|
INSITU HYBRIDIZATION AUTO
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 88367
|
| Hospital Charge Code |
22545746
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of AZ Commercial |
$923.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$164.16
|
| Rate for Payer: Banner UC Health Medicare |
$164.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$697.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$164.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$75.84
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna of AZ Commercial |
$666.90
|
| Rate for Payer: Devoted Health Medicare |
$184.68
|
| Rate for Payer: Humana of AZ Medicare |
$164.16
|
| Rate for Payer: Seven Corners Travel Insurance |
$554.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$697.68
|
| Rate for Payer: TriWest Medicare |
$164.16
|
| Rate for Payer: United Healthcare Commercial |
$586.87
|
| Rate for Payer: United Healthcare Medicare |
$164.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$162.52
|
|
|
INSITU HYBRIDIZATION AUTO
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 88367
|
| Hospital Charge Code |
22545746
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of AZ Commercial |
$923.40
|
| Rate for Payer: Cash Price |
$820.80
|
|
|
INSITU HYBRIDIZATION (FISH)
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
22545743
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$560.70 |
| Max. Negotiated Rate |
$560.70 |
| Rate for Payer: Aetna of AZ Commercial |
$560.70
|
| Rate for Payer: Cash Price |
$498.40
|
|
|
INSITU HYBRIDIZATION (FISH)
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
22545743
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.68 |
| Max. Negotiated Rate |
$560.70 |
| Rate for Payer: Aetna of AZ Commercial |
$560.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$99.68
|
| Rate for Payer: Banner UC Health Medicare |
$99.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$423.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$99.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$122.19
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cigna of AZ Commercial |
$404.95
|
| Rate for Payer: Devoted Health Medicare |
$112.14
|
| Rate for Payer: Humana of AZ Medicare |
$99.68
|
| Rate for Payer: Seven Corners Travel Insurance |
$263.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$423.64
|
| Rate for Payer: TriWest Medicare |
$99.68
|
| Rate for Payer: United Healthcare Commercial |
$356.36
|
| Rate for Payer: United Healthcare Medicare |
$99.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$98.68
|
|
|
INSITU HYBRIDIZATION MANUAL
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
22545747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna of AZ Commercial |
$841.50
|
| Rate for Payer: Cash Price |
$748.00
|
|
|
INSITU HYBRIDIZATION MANUAL
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
22545747
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.59 |
| Max. Negotiated Rate |
$841.50 |
| Rate for Payer: Aetna of AZ Commercial |
$841.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$149.60
|
| Rate for Payer: Banner UC Health Medicare |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$635.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$149.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$105.59
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna of AZ Commercial |
$607.75
|
| Rate for Payer: Devoted Health Medicare |
$168.30
|
| Rate for Payer: Humana of AZ Medicare |
$149.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$554.61
|
| Rate for Payer: Southwest Service Administrators UFCW |
$635.80
|
| Rate for Payer: TriWest Medicare |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$534.82
|
| Rate for Payer: United Healthcare Medicare |
$149.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$148.10
|
|
|
INSORB STAPLER
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
22598339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of AZ Commercial |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
|
|
INSORB STAPLER
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
22598339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of AZ Commercial |
$108.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$19.36
|
| Rate for Payer: Banner UC Health Medicare |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$19.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$19.36
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cigna of AZ Commercial |
$84.70
|
| Rate for Payer: Devoted Health Medicare |
$21.78
|
| Rate for Payer: Humana of AZ Medicare |
$19.36
|
| Rate for Payer: Southwest Service Administrators UFCW |
$82.28
|
| Rate for Payer: TriWest Medicare |
$19.36
|
| Rate for Payer: United Healthcare Commercial |
$69.21
|
| Rate for Payer: United Healthcare Medicare |
$19.36
|
| Rate for Payer: Veterans Affairs TRICARE |
$19.17
|
|
|
insulin 70-30 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.72
|
| Rate for Payer: Banner UC Health Medicare |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cigna of AZ Commercial |
$2.92
|
| Rate for Payer: Devoted Health Medicare |
$0.81
|
| Rate for Payer: Humana of AZ Medicare |
$0.72
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3.05
|
| Rate for Payer: TriWest Medicare |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.71
|
|
|
insulin 70-30 100 units/mL 3 mL Inj [CQCH]
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
105926789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna of AZ Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$3.59
|
|
