|
Orbit And Eye Procedures
|
Facility
|
IP
|
$6,265.61
|
|
|
Service Code
|
APR-DRG 0731
|
| Hospital Charge Code |
APRDRG0732
|
| Min. Negotiated Rate |
$6,265.61 |
| Max. Negotiated Rate |
$6,265.61 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,265.61
|
| Rate for Payer: Mercy Care Medicaid |
$6,265.61
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,265.61
|
|
|
Orbit And Eye Procedures
|
Facility
|
IP
|
$15,146.73
|
|
|
Service Code
|
APR-DRG 0733
|
| Hospital Charge Code |
APRDRG0733
|
| Min. Negotiated Rate |
$15,146.73 |
| Max. Negotiated Rate |
$15,146.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,146.73
|
| Rate for Payer: Mercy Care Medicaid |
$15,146.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,146.73
|
|
|
ORCA SUCTION WATER AND BIOPSY VALVE SET
|
Facility
|
IP
|
$50.10
|
|
| Hospital Charge Code |
27939097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Aetna of AZ Commercial |
$45.09
|
| Rate for Payer: Cash Price |
$40.08
|
|
|
ORCA SUCTION WATER AND BIOPSY VALVE SET
|
Facility
|
OP
|
$50.10
|
|
| Hospital Charge Code |
27939097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Aetna of AZ Commercial |
$45.09
|
| Rate for Payer: Arizona Complete Health Allwell |
$8.02
|
| Rate for Payer: Banner UC Health Medicare |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$34.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$8.02
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$40.08
|
| Rate for Payer: Cigna of AZ Commercial |
$35.07
|
| Rate for Payer: Devoted Health Medicare |
$9.02
|
| Rate for Payer: Humana of AZ Medicare |
$8.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$34.07
|
| Rate for Payer: TriWest Medicare |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare |
$8.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$7.94
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$20,793.67
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$20,793.67 |
| Max. Negotiated Rate |
$20,793.67 |
| Rate for Payer: Seven Corners Travel Insurance |
$20,793.67
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$3,070.73
|
|
|
Service Code
|
APR-DRG 7571
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$3,070.73 |
| Max. Negotiated Rate |
$3,070.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,070.73
|
| Rate for Payer: Mercy Care Medicaid |
$3,070.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,070.73
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7574
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,824.09
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$7,742.75
|
|
|
Service Code
|
APR-DRG 7573
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$7,742.75 |
| Max. Negotiated Rate |
$7,742.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,742.75
|
| Rate for Payer: Mercy Care Medicaid |
$7,742.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,742.75
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7572
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$4,086.36
|
|
|
Service Code
|
APR-DRG 7572
|
| Hospital Charge Code |
APRDRG7571
|
| Min. Negotiated Rate |
$4,086.36 |
| Max. Negotiated Rate |
$4,086.36 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,086.36
|
| Rate for Payer: Mercy Care Medicaid |
$4,086.36
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,086.36
|
|
|
Organic Mental Health Disturbances
|
Facility
|
IP
|
$14,824.09
|
|
|
Service Code
|
APR-DRG 7574
|
| Hospital Charge Code |
APRDRG7573
|
| Min. Negotiated Rate |
$14,824.09 |
| Max. Negotiated Rate |
$14,824.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$14,824.09
|
| Rate for Payer: Mercy Care Medicaid |
$14,824.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$14,824.09
|
|
|
ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR
|
Facility
|
IP
|
$803.00
|
|
| Hospital Charge Code |
23697416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$722.70 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Aetna of AZ Commercial |
$722.70
|
| Rate for Payer: Cash Price |
$642.40
|
|
|
ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR
|
Facility
|
OP
|
$803.00
|
|
| Hospital Charge Code |
23697416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Aetna of AZ Commercial |
$722.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$128.48
|
| Rate for Payer: Banner UC Health Medicare |
$128.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$546.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$128.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$128.48
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cigna of AZ Commercial |
$562.10
|
| Rate for Payer: Devoted Health Medicare |
$144.54
|
| Rate for Payer: Humana of AZ Medicare |
$128.48
|
| Rate for Payer: Southwest Service Administrators UFCW |
$546.04
|
| Rate for Payer: TriWest Medicare |
$128.48
|
| Rate for Payer: United Healthcare Commercial |
$459.32
|
| Rate for Payer: United Healthcare Medicare |
$128.48
|
| Rate for Payer: Veterans Affairs TRICARE |
$127.20
|
|
|
orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$7.12
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
105935017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna of AZ Commercial |
$6.41
|
| Rate for Payer: Cash Price |
$5.70
|
|
|
orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$7.12
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
105935017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna of AZ Commercial |
$6.41
|
| Rate for Payer: Arizona Complete Health Allwell |
$1.14
|
| Rate for Payer: Banner UC Health Medicare |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1.14
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1.14
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of AZ Commercial |
$4.63
|
| Rate for Payer: Devoted Health Medicare |
$1.28
|
| Rate for Payer: Humana of AZ Medicare |
$1.14
|
| Rate for Payer: Southwest Service Administrators UFCW |
$4.84
|
| Rate for Payer: TriWest Medicare |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: Veterans Affairs TRICARE |
$1.13
|
|
