|
Non-Hypovolemic Sodium Disorders
|
Facility
|
IP
|
$3,996.58
|
|
|
Service Code
|
APR-DRG 4262
|
| Hospital Charge Code |
APRDRG4264
|
| Min. Negotiated Rate |
$3,996.58 |
| Max. Negotiated Rate |
$3,996.58 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,996.58
|
| Rate for Payer: Mercy Care Medicaid |
$3,996.58
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,996.58
|
|
|
Non-Hypovolemic Sodium Disorders
|
Facility
|
IP
|
$12,041.64
|
|
|
Service Code
|
APR-DRG 4264
|
| Hospital Charge Code |
APRDRG4263
|
| Min. Negotiated Rate |
$12,041.64 |
| Max. Negotiated Rate |
$12,041.64 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,041.64
|
| Rate for Payer: Mercy Care Medicaid |
$12,041.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,041.64
|
|
|
Non-Hypovolemic Sodium Disorders
|
Facility
|
IP
|
$12,041.64
|
|
|
Service Code
|
APR-DRG 4264
|
| Hospital Charge Code |
APRDRG4261
|
| Min. Negotiated Rate |
$12,041.64 |
| Max. Negotiated Rate |
$12,041.64 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,041.64
|
| Rate for Payer: Mercy Care Medicaid |
$12,041.64
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,041.64
|
|
|
Non-Hypovolemic Sodium Disorders
|
Facility
|
IP
|
$6,071.32
|
|
|
Service Code
|
APR-DRG 4263
|
| Hospital Charge Code |
APRDRG4264
|
| Min. Negotiated Rate |
$6,071.32 |
| Max. Negotiated Rate |
$6,071.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,071.32
|
| Rate for Payer: Mercy Care Medicaid |
$6,071.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,071.32
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$13,553.74
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$13,553.74 |
| Max. Negotiated Rate |
$13,553.74 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,553.74
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,021.50
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$8,021.50 |
| Max. Negotiated Rate |
$8,021.50 |
| Rate for Payer: Seven Corners Travel Insurance |
$8,021.50
|
|
|
Non-pneum walk boot prefab
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
1902220
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
|
|
Non-pneum walk boot prefab
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
1902220
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of AZ Commercial |
$94.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$16.80
|
| Rate for Payer: Banner UC Health Medicare |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$16.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of AZ Commercial |
$73.50
|
| Rate for Payer: Devoted Health Medicare |
$18.90
|
| Rate for Payer: Humana of AZ Medicare |
$16.80
|
| Rate for Payer: Southwest Service Administrators UFCW |
$71.40
|
| Rate for Payer: TriWest Medicare |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$60.06
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$16.63
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$4,874.03
|
|
|
Service Code
|
APR-DRG 0461
|
| Hospital Charge Code |
APRDRG0463
|
| Min. Negotiated Rate |
$4,874.03 |
| Max. Negotiated Rate |
$4,874.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,874.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,874.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,874.03
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$4,874.03
|
|
|
Service Code
|
APR-DRG 0461
|
| Hospital Charge Code |
APRDRG0462
|
| Min. Negotiated Rate |
$4,874.03 |
| Max. Negotiated Rate |
$4,874.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,874.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,874.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,874.03
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$13,441.63
|
|
|
Service Code
|
APR-DRG 0464
|
| Hospital Charge Code |
APRDRG0461
|
| Min. Negotiated Rate |
$13,441.63 |
| Max. Negotiated Rate |
$13,441.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,441.63
|
| Rate for Payer: Mercy Care Medicaid |
$13,441.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,441.63
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$13,441.63
|
|
|
Service Code
|
APR-DRG 0464
|
| Hospital Charge Code |
APRDRG0463
|
| Min. Negotiated Rate |
$13,441.63 |
| Max. Negotiated Rate |
$13,441.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,441.63
|
| Rate for Payer: Mercy Care Medicaid |
$13,441.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,441.63
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$7,488.15
|
|
|
Service Code
|
APR-DRG 0463
|
| Hospital Charge Code |
APRDRG0463
|
| Min. Negotiated Rate |
$7,488.15 |
| Max. Negotiated Rate |
$7,488.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,488.15
|
| Rate for Payer: Mercy Care Medicaid |
$7,488.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,488.15
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$4,874.03
|
|
|
Service Code
|
APR-DRG 0461
|
| Hospital Charge Code |
APRDRG0461
|
| Min. Negotiated Rate |
$4,874.03 |
| Max. Negotiated Rate |
$4,874.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,874.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,874.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,874.03
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$13,441.63
|
|
|
Service Code
|
APR-DRG 0464
|
| Hospital Charge Code |
APRDRG0464
|
| Min. Negotiated Rate |
$13,441.63 |
| Max. Negotiated Rate |
$13,441.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,441.63
|
| Rate for Payer: Mercy Care Medicaid |
$13,441.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,441.63
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$7,488.15
|
|
|
Service Code
|
APR-DRG 0463
|
| Hospital Charge Code |
APRDRG0464
|
| Min. Negotiated Rate |
$7,488.15 |
| Max. Negotiated Rate |
$7,488.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,488.15
|
| Rate for Payer: Mercy Care Medicaid |
$7,488.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,488.15
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$5,677.83
|
|
|
Service Code
|
APR-DRG 0462
|
| Hospital Charge Code |
APRDRG0462
|
| Min. Negotiated Rate |
$5,677.83 |
| Max. Negotiated Rate |
$5,677.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,677.83
|
| Rate for Payer: Mercy Care Medicaid |
$5,677.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,677.83
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$5,677.83
|
|
|
Service Code
|
APR-DRG 0462
|
| Hospital Charge Code |
APRDRG0461
|
| Min. Negotiated Rate |
$5,677.83 |
| Max. Negotiated Rate |
$5,677.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,677.83
|
| Rate for Payer: Mercy Care Medicaid |
$5,677.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,677.83
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$5,677.83
|
|
|
Service Code
|
APR-DRG 0462
|
| Hospital Charge Code |
APRDRG0464
|
| Min. Negotiated Rate |
$5,677.83 |
| Max. Negotiated Rate |
$5,677.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,677.83
|
| Rate for Payer: Mercy Care Medicaid |
$5,677.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,677.83
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$7,488.15
|
|
|
Service Code
|
APR-DRG 0463
|
| Hospital Charge Code |
APRDRG0461
|
| Min. Negotiated Rate |
$7,488.15 |
| Max. Negotiated Rate |
$7,488.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,488.15
|
| Rate for Payer: Mercy Care Medicaid |
$7,488.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,488.15
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$4,874.03
|
|
|
Service Code
|
APR-DRG 0461
|
| Hospital Charge Code |
APRDRG0464
|
| Min. Negotiated Rate |
$4,874.03 |
| Max. Negotiated Rate |
$4,874.03 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,874.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,874.03
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,874.03
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$7,488.15
|
|
|
Service Code
|
APR-DRG 0463
|
| Hospital Charge Code |
APRDRG0462
|
| Min. Negotiated Rate |
$7,488.15 |
| Max. Negotiated Rate |
$7,488.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,488.15
|
| Rate for Payer: Mercy Care Medicaid |
$7,488.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,488.15
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$13,441.63
|
|
|
Service Code
|
APR-DRG 0464
|
| Hospital Charge Code |
APRDRG0462
|
| Min. Negotiated Rate |
$13,441.63 |
| Max. Negotiated Rate |
$13,441.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,441.63
|
| Rate for Payer: Mercy Care Medicaid |
$13,441.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,441.63
|
|
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
Facility
|
IP
|
$5,677.83
|
|
|
Service Code
|
APR-DRG 0462
|
| Hospital Charge Code |
APRDRG0463
|
| Min. Negotiated Rate |
$5,677.83 |
| Max. Negotiated Rate |
$5,677.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,677.83
|
| Rate for Payer: Mercy Care Medicaid |
$5,677.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,677.83
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$23,392.68
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$23,392.68 |
| Max. Negotiated Rate |
$23,392.68 |
| Rate for Payer: Seven Corners Travel Insurance |
$23,392.68
|
|
