|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$47,894.27
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$47,894.27 |
| Max. Negotiated Rate |
$47,894.27 |
| Rate for Payer: Seven Corners Travel Insurance |
$47,894.27
|
|
|
KIT CATH 2 LUMEN 4FR
|
Facility
|
IP
|
$323.00
|
|
| Hospital Charge Code |
22354825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna of AZ Commercial |
$290.70
|
| Rate for Payer: Cash Price |
$258.40
|
|
|
KIT CATH 2 LUMEN 4FR
|
Facility
|
OP
|
$323.00
|
|
| Hospital Charge Code |
22354825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna of AZ Commercial |
$290.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$51.68
|
| Rate for Payer: Banner UC Health Medicare |
$51.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$219.64
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$51.68
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$51.68
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cigna of AZ Commercial |
$226.10
|
| Rate for Payer: Devoted Health Medicare |
$58.14
|
| Rate for Payer: Humana of AZ Medicare |
$51.68
|
| Rate for Payer: Southwest Service Administrators UFCW |
$219.64
|
| Rate for Payer: TriWest Medicare |
$51.68
|
| Rate for Payer: United Healthcare Commercial |
$184.76
|
| Rate for Payer: United Healthcare Medicare |
$51.68
|
| Rate for Payer: Veterans Affairs TRICARE |
$51.16
|
|
|
KIT CATH CAVITY DRAINAGE
|
Facility
|
OP
|
$475.00
|
|
| Hospital Charge Code |
22354826
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna of AZ Commercial |
$427.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$76.00
|
| Rate for Payer: Banner UC Health Medicare |
$76.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$76.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$76.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna of AZ Commercial |
$332.50
|
| Rate for Payer: Devoted Health Medicare |
$85.50
|
| Rate for Payer: Humana of AZ Medicare |
$76.00
|
| Rate for Payer: Southwest Service Administrators UFCW |
$323.00
|
| Rate for Payer: TriWest Medicare |
$76.00
|
| Rate for Payer: United Healthcare Commercial |
$271.70
|
| Rate for Payer: United Healthcare Medicare |
$76.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$75.24
|
|
|
KIT CATH CAVITY DRAINAGE
|
Facility
|
IP
|
$475.00
|
|
| Hospital Charge Code |
22354826
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna of AZ Commercial |
$427.50
|
| Rate for Payer: Cash Price |
$380.00
|
|
|
KIT CATH CRICOTHYROTOMY
|
Facility
|
IP
|
$1,474.00
|
|
| Hospital Charge Code |
22354208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,326.60 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Cash Price |
$1,179.20
|
|
|
KIT CATH CRICOTHYROTOMY
|
Facility
|
OP
|
$1,474.00
|
|
| Hospital Charge Code |
22354208
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$233.48 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,326.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$235.84
|
| Rate for Payer: Banner UC Health Medicare |
$235.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,002.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$235.84
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$235.84
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,031.80
|
| Rate for Payer: Devoted Health Medicare |
$265.32
|
| Rate for Payer: Humana of AZ Medicare |
$235.84
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,002.32
|
| Rate for Payer: TriWest Medicare |
$235.84
|
| Rate for Payer: United Healthcare Commercial |
$843.13
|
| Rate for Payer: United Healthcare Medicare |
$235.84
|
| Rate for Payer: Veterans Affairs TRICARE |
$233.48
|
|
|
KIT CATH MULTI-LUMEN CENTRAL VENOUS
|
Facility
|
IP
|
$539.00
|
|
| Hospital Charge Code |
22354827
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Aetna of AZ Commercial |
$485.10
|
| Rate for Payer: Cash Price |
$431.20
|
|
|
KIT CATH MULTI-LUMEN CENTRAL VENOUS
|
Facility
|
OP
|
$539.00
|
|
| Hospital Charge Code |
22354827
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Aetna of AZ Commercial |
$485.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$86.24
|
| Rate for Payer: Banner UC Health Medicare |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$366.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$86.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$86.24
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cigna of AZ Commercial |
$377.30
|
| Rate for Payer: Devoted Health Medicare |
$97.02
|
| Rate for Payer: Humana of AZ Medicare |
$86.24
|
| Rate for Payer: Southwest Service Administrators UFCW |
$366.52
|
| Rate for Payer: TriWest Medicare |
$86.24
|
| Rate for Payer: United Healthcare Commercial |
$308.31
|
| Rate for Payer: United Healthcare Medicare |
$86.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$85.38
|
|
|
KIT ENEMA DISPOSABLE EZ EM
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
22355114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
|
|
KIT ENEMA DISPOSABLE EZ EM
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
22355114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of AZ Commercial |
$31.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.60
|
| Rate for Payer: Banner UC Health Medicare |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of AZ Commercial |
$24.50
|
| Rate for Payer: Devoted Health Medicare |
$6.30
|
| Rate for Payer: Humana of AZ Medicare |
$5.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$23.80
|
| Rate for Payer: TriWest Medicare |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$20.02
|
| Rate for Payer: United Healthcare Medicare |
$5.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.54
|
|
|
KIT EXPIR DATE
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
22012070
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
|
|
KIT EXPIR DATE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
22012070
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of AZ Commercial |
$69.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.32
|
| Rate for Payer: Banner UC Health Medicare |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of AZ Commercial |
$53.90
|
| Rate for Payer: Devoted Health Medicare |
$13.86
|
| Rate for Payer: Humana of AZ Medicare |
$12.32
|
| Rate for Payer: Seven Corners Travel Insurance |
$17.37
|
| Rate for Payer: Southwest Service Administrators UFCW |
$52.36
|
| Rate for Payer: TriWest Medicare |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$44.04
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.20
|
|
|
KIT LAPAROSCOPIC MORCELLATOR
|
Facility
|
IP
|
$3,378.00
|
|
| Hospital Charge Code |
22354835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,040.20 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,040.20
|
| Rate for Payer: Cash Price |
$2,702.40
|
|
|
KIT LAPAROSCOPIC MORCELLATOR
|
Facility
|
OP
|
$3,378.00
|
|
| Hospital Charge Code |
22354835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna of AZ Commercial |
$3,040.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$540.48
|
| Rate for Payer: Banner UC Health Medicare |
$540.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2,297.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$540.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$540.48
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cigna of AZ Commercial |
$2,364.60
|
| Rate for Payer: Devoted Health Medicare |
$608.04
|
| Rate for Payer: Humana of AZ Medicare |
$540.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2,297.04
|
| Rate for Payer: TriWest Medicare |
$540.48
|
| Rate for Payer: United Healthcare Commercial |
$1,932.22
|
| Rate for Payer: United Healthcare Medicare |
$540.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$535.08
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3134
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3132
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$17,227.09
|
|
|
Service Code
|
APR-DRG 3133
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$17,227.09 |
| Max. Negotiated Rate |
$17,227.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,227.09
|
| Rate for Payer: Mercy Care Medicaid |
$17,227.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,227.09
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$11,014.79
|
|
|
Service Code
|
APR-DRG 3132
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$11,014.79 |
| Max. Negotiated Rate |
$11,014.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,014.79
|
| Rate for Payer: Mercy Care Medicaid |
$11,014.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,014.79
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$8,129.93
|
|
|
Service Code
|
APR-DRG 3131
|
| Hospital Charge Code |
APRDRG3133
|
| Min. Negotiated Rate |
$8,129.93 |
| Max. Negotiated Rate |
$8,129.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,129.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,129.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,129.93
|
|
|
Knee And Lower Leg Procedures Except Foot
|
Facility
|
IP
|
$28,088.97
|
|
|
Service Code
|
APR-DRG 3134
|
| Hospital Charge Code |
APRDRG3131
|
| Min. Negotiated Rate |
$28,088.97 |
| Max. Negotiated Rate |
$28,088.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,088.97
|
| Rate for Payer: Mercy Care Medicaid |
$28,088.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,088.97
|
|
