|
MOD COMPLEXITY OBSERVATION CHARGE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
22331365
|
| Min. Negotiated Rate |
$70.49 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna of AZ Commercial |
$400.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$71.20
|
| Rate for Payer: Banner UC Health Medicare |
$71.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$71.20
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$71.20
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna of AZ Commercial |
$311.50
|
| Rate for Payer: Devoted Health Medicare |
$80.10
|
| Rate for Payer: Humana of AZ Medicare |
$71.20
|
| Rate for Payer: Southwest Service Administrators UFCW |
$302.60
|
| Rate for Payer: TriWest Medicare |
$71.20
|
| Rate for Payer: United Healthcare Commercial |
$254.54
|
| Rate for Payer: United Healthcare Medicare |
$71.20
|
| Rate for Payer: Veterans Affairs TRICARE |
$70.49
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$6,242.46
|
|
|
Service Code
|
APR-DRG 7931
|
| Hospital Charge Code |
APRDRG7934
|
| Min. Negotiated Rate |
$6,242.46 |
| Max. Negotiated Rate |
$6,242.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,242.46
|
| Rate for Payer: Mercy Care Medicaid |
$6,242.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,242.46
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$6,242.46
|
|
|
Service Code
|
APR-DRG 7931
|
| Hospital Charge Code |
APRDRG7932
|
| Min. Negotiated Rate |
$6,242.46 |
| Max. Negotiated Rate |
$6,242.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,242.46
|
| Rate for Payer: Mercy Care Medicaid |
$6,242.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,242.46
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$28,319.03
|
|
|
Service Code
|
APR-DRG 7934
|
| Hospital Charge Code |
APRDRG7934
|
| Min. Negotiated Rate |
$28,319.03 |
| Max. Negotiated Rate |
$28,319.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,319.03
|
| Rate for Payer: Mercy Care Medicaid |
$28,319.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,319.03
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$8,863.59
|
|
|
Service Code
|
APR-DRG 7932
|
| Hospital Charge Code |
APRDRG7933
|
| Min. Negotiated Rate |
$8,863.59 |
| Max. Negotiated Rate |
$8,863.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,863.59
|
| Rate for Payer: Mercy Care Medicaid |
$8,863.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,863.59
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$14,150.75
|
|
|
Service Code
|
APR-DRG 7933
|
| Hospital Charge Code |
APRDRG7932
|
| Min. Negotiated Rate |
$14,150.75 |
| Max. Negotiated Rate |
$14,150.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,150.75
|
| Rate for Payer: Mercy Care Medicaid |
$14,150.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,150.75
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$14,150.75
|
|
|
Service Code
|
APR-DRG 7933
|
| Hospital Charge Code |
APRDRG7934
|
| Min. Negotiated Rate |
$14,150.75 |
| Max. Negotiated Rate |
$14,150.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,150.75
|
| Rate for Payer: Mercy Care Medicaid |
$14,150.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,150.75
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$8,863.59
|
|
|
Service Code
|
APR-DRG 7932
|
| Hospital Charge Code |
APRDRG7932
|
| Min. Negotiated Rate |
$8,863.59 |
| Max. Negotiated Rate |
$8,863.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,863.59
|
| Rate for Payer: Mercy Care Medicaid |
$8,863.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,863.59
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$14,150.75
|
|
|
Service Code
|
APR-DRG 7933
|
| Hospital Charge Code |
APRDRG7933
|
| Min. Negotiated Rate |
$14,150.75 |
| Max. Negotiated Rate |
$14,150.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,150.75
|
| Rate for Payer: Mercy Care Medicaid |
$14,150.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,150.75
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$28,319.03
|
|
|
Service Code
|
APR-DRG 7934
|
| Hospital Charge Code |
APRDRG7933
|
| Min. Negotiated Rate |
$28,319.03 |
| Max. Negotiated Rate |
$28,319.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,319.03
|
| Rate for Payer: Mercy Care Medicaid |
$28,319.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,319.03
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$28,319.03
|
|
|
Service Code
|
APR-DRG 7934
|
| Hospital Charge Code |
APRDRG7931
|
| Min. Negotiated Rate |
$28,319.03 |
| Max. Negotiated Rate |
$28,319.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,319.03
|
| Rate for Payer: Mercy Care Medicaid |
$28,319.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,319.03
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$14,150.75
|
|
|
Service Code
|
APR-DRG 7933
|
| Hospital Charge Code |
APRDRG7931
|
| Min. Negotiated Rate |
$14,150.75 |
| Max. Negotiated Rate |
$14,150.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,150.75
|
| Rate for Payer: Mercy Care Medicaid |
$14,150.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,150.75
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$8,863.59
|
|
|
Service Code
|
APR-DRG 7932
|
| Hospital Charge Code |
APRDRG7934
|
| Min. Negotiated Rate |
$8,863.59 |
| Max. Negotiated Rate |
$8,863.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,863.59
|
| Rate for Payer: Mercy Care Medicaid |
$8,863.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,863.59
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$6,242.46
|
|
|
Service Code
|
APR-DRG 7931
|
| Hospital Charge Code |
APRDRG7933
|
| Min. Negotiated Rate |
$6,242.46 |
| Max. Negotiated Rate |
$6,242.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,242.46
|
| Rate for Payer: Mercy Care Medicaid |
$6,242.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,242.46
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$8,863.59
|
|
|
Service Code
|
APR-DRG 7932
|
| Hospital Charge Code |
APRDRG7931
|
| Min. Negotiated Rate |
$8,863.59 |
| Max. Negotiated Rate |
$8,863.59 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,863.59
|
| Rate for Payer: Mercy Care Medicaid |
$8,863.59
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,863.59
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$6,242.46
|
|
|
Service Code
|
APR-DRG 7931
|
| Hospital Charge Code |
APRDRG7931
|
| Min. Negotiated Rate |
$6,242.46 |
| Max. Negotiated Rate |
$6,242.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,242.46
|
| Rate for Payer: Mercy Care Medicaid |
$6,242.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,242.46
|
|
|
Moderately Extensive O.R. Procedures For Other Complications Of Treatment
|
Facility
|
IP
|
$28,319.03
|
|
|
Service Code
|
APR-DRG 7934
|
| Hospital Charge Code |
APRDRG7932
|
| Min. Negotiated Rate |
$28,319.03 |
| Max. Negotiated Rate |
$28,319.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$28,319.03
|
| Rate for Payer: Mercy Care Medicaid |
$28,319.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$28,319.03
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$15,718.37
|
|
|
Service Code
|
APR-DRG 9513
|
| Hospital Charge Code |
APRDRG9514
|
| Min. Negotiated Rate |
$15,718.37 |
| Max. Negotiated Rate |
$15,718.37 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,718.37
|
| Rate for Payer: Mercy Care Medicaid |
$15,718.37
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,718.37
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$15,718.37
|
|
|
Service Code
|
APR-DRG 9513
|
| Hospital Charge Code |
APRDRG9512
|
| Min. Negotiated Rate |
$15,718.37 |
| Max. Negotiated Rate |
$15,718.37 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,718.37
|
| Rate for Payer: Mercy Care Medicaid |
$15,718.37
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,718.37
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$6,929.83
|
|
|
Service Code
|
APR-DRG 9511
|
| Hospital Charge Code |
APRDRG9514
|
| Min. Negotiated Rate |
$6,929.83 |
| Max. Negotiated Rate |
$6,929.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,929.83
|
| Rate for Payer: Mercy Care Medicaid |
$6,929.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,929.83
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$10,065.79
|
|
|
Service Code
|
APR-DRG 9512
|
| Hospital Charge Code |
APRDRG9514
|
| Min. Negotiated Rate |
$10,065.79 |
| Max. Negotiated Rate |
$10,065.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,065.79
|
| Rate for Payer: Mercy Care Medicaid |
$10,065.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,065.79
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$29,766.71
|
|
|
Service Code
|
APR-DRG 9514
|
| Hospital Charge Code |
APRDRG9513
|
| Min. Negotiated Rate |
$29,766.71 |
| Max. Negotiated Rate |
$29,766.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,766.71
|
| Rate for Payer: Mercy Care Medicaid |
$29,766.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,766.71
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$29,766.71
|
|
|
Service Code
|
APR-DRG 9514
|
| Hospital Charge Code |
APRDRG9514
|
| Min. Negotiated Rate |
$29,766.71 |
| Max. Negotiated Rate |
$29,766.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,766.71
|
| Rate for Payer: Mercy Care Medicaid |
$29,766.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,766.71
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$29,766.71
|
|
|
Service Code
|
APR-DRG 9514
|
| Hospital Charge Code |
APRDRG9512
|
| Min. Negotiated Rate |
$29,766.71 |
| Max. Negotiated Rate |
$29,766.71 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,766.71
|
| Rate for Payer: Mercy Care Medicaid |
$29,766.71
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,766.71
|
|
|
Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis
|
Facility
|
IP
|
$6,929.83
|
|
|
Service Code
|
APR-DRG 9511
|
| Hospital Charge Code |
APRDRG9513
|
| Min. Negotiated Rate |
$6,929.83 |
| Max. Negotiated Rate |
$6,929.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,929.83
|
| Rate for Payer: Mercy Care Medicaid |
$6,929.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,929.83
|
|
