|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$7,417.31
|
|
|
Service Code
|
APR-DRG 3101
|
| Hospital Charge Code |
APRDRG3101
|
| Min. Negotiated Rate |
$7,417.31 |
| Max. Negotiated Rate |
$7,417.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,417.31
|
| Rate for Payer: Mercy Care Medicaid |
$7,417.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,417.31
|
|
|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$7,417.31
|
|
|
Service Code
|
APR-DRG 3101
|
| Hospital Charge Code |
APRDRG3103
|
| Min. Negotiated Rate |
$7,417.31 |
| Max. Negotiated Rate |
$7,417.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,417.31
|
| Rate for Payer: Mercy Care Medicaid |
$7,417.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,417.31
|
|
|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$26,829.25
|
|
|
Service Code
|
APR-DRG 3104
|
| Hospital Charge Code |
APRDRG3103
|
| Min. Negotiated Rate |
$26,829.25 |
| Max. Negotiated Rate |
$26,829.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,829.25
|
| Rate for Payer: Mercy Care Medicaid |
$26,829.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,829.25
|
|
|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$9,515.89
|
|
|
Service Code
|
APR-DRG 3102
|
| Hospital Charge Code |
APRDRG3102
|
| Min. Negotiated Rate |
$9,515.89 |
| Max. Negotiated Rate |
$9,515.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,515.89
|
| Rate for Payer: Mercy Care Medicaid |
$9,515.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,515.89
|
|
|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$7,417.31
|
|
|
Service Code
|
APR-DRG 3101
|
| Hospital Charge Code |
APRDRG3104
|
| Min. Negotiated Rate |
$7,417.31 |
| Max. Negotiated Rate |
$7,417.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,417.31
|
| Rate for Payer: Mercy Care Medicaid |
$7,417.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,417.31
|
|
|
Intervertebral Disc Excision And Decompression
|
Facility
|
IP
|
$26,829.25
|
|
|
Service Code
|
APR-DRG 3104
|
| Hospital Charge Code |
APRDRG3104
|
| Min. Negotiated Rate |
$26,829.25 |
| Max. Negotiated Rate |
$26,829.25 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,829.25
|
| Rate for Payer: Mercy Care Medicaid |
$26,829.25
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,829.25
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$4,125.63
|
|
|
Service Code
|
APR-DRG 2472
|
| Hospital Charge Code |
APRDRG2473
|
| Min. Negotiated Rate |
$4,125.63 |
| Max. Negotiated Rate |
$4,125.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,125.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,125.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,125.63
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$3,100.19
|
|
|
Service Code
|
APR-DRG 2471
|
| Hospital Charge Code |
APRDRG2474
|
| Min. Negotiated Rate |
$3,100.19 |
| Max. Negotiated Rate |
$3,100.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.19
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.19
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$6,678.73
|
|
|
Service Code
|
APR-DRG 2473
|
| Hospital Charge Code |
APRDRG2471
|
| Min. Negotiated Rate |
$6,678.73 |
| Max. Negotiated Rate |
$6,678.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,678.73
|
| Rate for Payer: Mercy Care Medicaid |
$6,678.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,678.73
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$12,767.58
|
|
|
Service Code
|
APR-DRG 2474
|
| Hospital Charge Code |
APRDRG2474
|
| Min. Negotiated Rate |
$12,767.58 |
| Max. Negotiated Rate |
$12,767.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,767.58
|
| Rate for Payer: Mercy Care Medicaid |
$12,767.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,767.58
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$6,678.73
|
|
|
Service Code
|
APR-DRG 2473
|
| Hospital Charge Code |
APRDRG2474
|
| Min. Negotiated Rate |
$6,678.73 |
| Max. Negotiated Rate |
$6,678.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,678.73
|
| Rate for Payer: Mercy Care Medicaid |
$6,678.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,678.73
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$12,767.58
|
|
|
Service Code
|
APR-DRG 2474
|
| Hospital Charge Code |
APRDRG2471
|
| Min. Negotiated Rate |
$12,767.58 |
| Max. Negotiated Rate |
$12,767.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,767.58
|
| Rate for Payer: Mercy Care Medicaid |
$12,767.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,767.58
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$4,125.63
|
|
|
Service Code
|
APR-DRG 2472
|
| Hospital Charge Code |
APRDRG2472
|
| Min. Negotiated Rate |
$4,125.63 |
| Max. Negotiated Rate |
$4,125.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,125.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,125.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,125.63
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$3,100.19
|
|
|
Service Code
|
APR-DRG 2471
|
| Hospital Charge Code |
APRDRG2472
|
| Min. Negotiated Rate |
$3,100.19 |
| Max. Negotiated Rate |
$3,100.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.19
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.19
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$3,100.19
|
|
|
Service Code
|
APR-DRG 2471
|
| Hospital Charge Code |
APRDRG2471
|
| Min. Negotiated Rate |
$3,100.19 |
| Max. Negotiated Rate |
$3,100.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.19
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.19
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$3,100.19
|
|
|
Service Code
|
APR-DRG 2471
|
| Hospital Charge Code |
APRDRG2473
|
| Min. Negotiated Rate |
$3,100.19 |
| Max. Negotiated Rate |
$3,100.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.19
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.19
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$6,678.73
|
|
|
Service Code
|
APR-DRG 2473
|
| Hospital Charge Code |
APRDRG2473
|
| Min. Negotiated Rate |
$6,678.73 |
| Max. Negotiated Rate |
$6,678.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,678.73
|
| Rate for Payer: Mercy Care Medicaid |
$6,678.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,678.73
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$4,125.63
|
|
|
Service Code
|
APR-DRG 2472
|
| Hospital Charge Code |
APRDRG2471
|
| Min. Negotiated Rate |
$4,125.63 |
| Max. Negotiated Rate |
$4,125.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,125.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,125.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,125.63
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$6,678.73
|
|
|
Service Code
|
APR-DRG 2473
|
| Hospital Charge Code |
APRDRG2472
|
| Min. Negotiated Rate |
$6,678.73 |
| Max. Negotiated Rate |
$6,678.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,678.73
|
| Rate for Payer: Mercy Care Medicaid |
$6,678.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,678.73
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$12,767.58
|
|
|
Service Code
|
APR-DRG 2474
|
| Hospital Charge Code |
APRDRG2472
|
| Min. Negotiated Rate |
$12,767.58 |
| Max. Negotiated Rate |
$12,767.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,767.58
|
| Rate for Payer: Mercy Care Medicaid |
$12,767.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,767.58
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$4,125.63
|
|
|
Service Code
|
APR-DRG 2472
|
| Hospital Charge Code |
APRDRG2474
|
| Min. Negotiated Rate |
$4,125.63 |
| Max. Negotiated Rate |
$4,125.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,125.63
|
| Rate for Payer: Mercy Care Medicaid |
$4,125.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,125.63
|
|
|
Intestinal Obstruction
|
Facility
|
IP
|
$12,767.58
|
|
|
Service Code
|
APR-DRG 2474
|
| Hospital Charge Code |
APRDRG2473
|
| Min. Negotiated Rate |
$12,767.58 |
| Max. Negotiated Rate |
$12,767.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,767.58
|
| Rate for Payer: Mercy Care Medicaid |
$12,767.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,767.58
|
|
|
INTOCAN SAFETY DEEP ACCESS IV CATH 22G
|
Facility
|
OP
|
$41.37
|
|
| Hospital Charge Code |
27685140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$37.23 |
| Rate for Payer: Aetna of AZ Commercial |
$37.23
|
| Rate for Payer: Arizona Complete Health Allwell |
$6.62
|
| Rate for Payer: Banner UC Health Medicare |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$28.13
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$6.62
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$6.62
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of AZ Commercial |
$28.96
|
| Rate for Payer: Devoted Health Medicare |
$7.45
|
| Rate for Payer: Humana of AZ Medicare |
$6.62
|
| Rate for Payer: Southwest Service Administrators UFCW |
$28.13
|
| Rate for Payer: TriWest Medicare |
$6.62
|
| Rate for Payer: United Healthcare Commercial |
$23.66
|
| Rate for Payer: United Healthcare Medicare |
$6.62
|
| Rate for Payer: Veterans Affairs TRICARE |
$6.55
|
|
|
INTOCAN SAFETY DEEP ACCESS IV CATH 22G
|
Facility
|
IP
|
$41.37
|
|
| Hospital Charge Code |
27685140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$37.23 |
| Rate for Payer: Aetna of AZ Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$33.10
|
|
|
Intracranial Hemorrhage
|
Facility
|
IP
|
$5,516.51
|
|
|
Service Code
|
APR-DRG 0441
|
| Hospital Charge Code |
APRDRG0443
|
| Min. Negotiated Rate |
$5,516.51 |
| Max. Negotiated Rate |
$5,516.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,516.51
|
| Rate for Payer: Mercy Care Medicaid |
$5,516.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,516.51
|
|
