|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$98,480.68
|
|
|
Service Code
|
MSDRG 957
|
| Min. Negotiated Rate |
$98,480.68 |
| Max. Negotiated Rate |
$98,480.68 |
| Rate for Payer: Seven Corners Travel Insurance |
$98,480.68
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$38,049.97
|
|
|
Service Code
|
MSDRG 959
|
| Min. Negotiated Rate |
$38,049.97 |
| Max. Negotiated Rate |
$38,049.97 |
| Rate for Payer: Seven Corners Travel Insurance |
$38,049.97
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$24,024.70
|
|
|
Service Code
|
MSDRG 803
|
| Min. Negotiated Rate |
$24,024.70 |
| Max. Negotiated Rate |
$24,024.70 |
| Rate for Payer: Seven Corners Travel Insurance |
$24,024.70
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$51,491.05
|
|
|
Service Code
|
MSDRG 802
|
| Min. Negotiated Rate |
$51,491.05 |
| Max. Negotiated Rate |
$51,491.05 |
| Rate for Payer: Seven Corners Travel Insurance |
$51,491.05
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,537.56
|
|
|
Service Code
|
MSDRG 804
|
| Min. Negotiated Rate |
$17,537.56 |
| Max. Negotiated Rate |
$17,537.56 |
| Rate for Payer: Seven Corners Travel Insurance |
$17,537.56
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$32,208.99
|
|
|
Service Code
|
APR-DRG 0294
|
| Hospital Charge Code |
APRDRG0294
|
| Min. Negotiated Rate |
$32,208.99 |
| Max. Negotiated Rate |
$32,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$32,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,208.99
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$32,208.99
|
|
|
Service Code
|
APR-DRG 0294
|
| Hospital Charge Code |
APRDRG0291
|
| Min. Negotiated Rate |
$32,208.99 |
| Max. Negotiated Rate |
$32,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$32,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,208.99
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0291
|
| Hospital Charge Code |
APRDRG0292
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0291
|
| Hospital Charge Code |
APRDRG0291
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$17,934.10
|
|
|
Service Code
|
APR-DRG 0293
|
| Hospital Charge Code |
APRDRG0292
|
| Min. Negotiated Rate |
$17,934.10 |
| Max. Negotiated Rate |
$17,934.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,934.10
|
| Rate for Payer: Mercy Care Medicaid |
$17,934.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,934.10
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0291
|
| Hospital Charge Code |
APRDRG0293
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$17,934.10
|
|
|
Service Code
|
APR-DRG 0293
|
| Hospital Charge Code |
APRDRG0293
|
| Min. Negotiated Rate |
$17,934.10 |
| Max. Negotiated Rate |
$17,934.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,934.10
|
| Rate for Payer: Mercy Care Medicaid |
$17,934.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,934.10
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$17,934.10
|
|
|
Service Code
|
APR-DRG 0293
|
| Hospital Charge Code |
APRDRG0291
|
| Min. Negotiated Rate |
$17,934.10 |
| Max. Negotiated Rate |
$17,934.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,934.10
|
| Rate for Payer: Mercy Care Medicaid |
$17,934.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,934.10
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0292
|
| Hospital Charge Code |
APRDRG0291
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$32,208.99
|
|
|
Service Code
|
APR-DRG 0294
|
| Hospital Charge Code |
APRDRG0293
|
| Min. Negotiated Rate |
$32,208.99 |
| Max. Negotiated Rate |
$32,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$32,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,208.99
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0291
|
| Hospital Charge Code |
APRDRG0294
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0292
|
| Hospital Charge Code |
APRDRG0292
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$17,934.10
|
|
|
Service Code
|
APR-DRG 0293
|
| Hospital Charge Code |
APRDRG0294
|
| Min. Negotiated Rate |
$17,934.10 |
| Max. Negotiated Rate |
$17,934.10 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,934.10
|
| Rate for Payer: Mercy Care Medicaid |
$17,934.10
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,934.10
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0292
|
| Hospital Charge Code |
APRDRG0294
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$13,233.31
|
|
|
Service Code
|
APR-DRG 0292
|
| Hospital Charge Code |
APRDRG0293
|
| Min. Negotiated Rate |
$13,233.31 |
| Max. Negotiated Rate |
$13,233.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,233.31
|
| Rate for Payer: Mercy Care Medicaid |
$13,233.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,233.31
|
|
|
Other Percutaneous Intracranial Procedures
|
Facility
|
IP
|
$32,208.99
|
|
|
Service Code
|
APR-DRG 0294
|
| Hospital Charge Code |
APRDRG0292
|
| Min. Negotiated Rate |
$32,208.99 |
| Max. Negotiated Rate |
$32,208.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,208.99
|
| Rate for Payer: Mercy Care Medicaid |
$32,208.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,208.99
|
|
|
Other Peripheral Vascular Procedures
|
Facility
|
IP
|
$31,432.54
|
|
|
Service Code
|
APR-DRG 1824
|
| Hospital Charge Code |
APRDRG1821
|
| Min. Negotiated Rate |
$31,432.54 |
| Max. Negotiated Rate |
$31,432.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$31,432.54
|
| Rate for Payer: Mercy Care Medicaid |
$31,432.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$31,432.54
|
|
|
Other Peripheral Vascular Procedures
|
Facility
|
IP
|
$12,827.20
|
|
|
Service Code
|
APR-DRG 1821
|
| Hospital Charge Code |
APRDRG1824
|
| Min. Negotiated Rate |
$12,827.20 |
| Max. Negotiated Rate |
$12,827.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,827.20
|
| Rate for Payer: Mercy Care Medicaid |
$12,827.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,827.20
|
|
|
Other Peripheral Vascular Procedures
|
Facility
|
IP
|
$31,432.54
|
|
|
Service Code
|
APR-DRG 1824
|
| Hospital Charge Code |
APRDRG1823
|
| Min. Negotiated Rate |
$31,432.54 |
| Max. Negotiated Rate |
$31,432.54 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$31,432.54
|
| Rate for Payer: Mercy Care Medicaid |
$31,432.54
|
| Rate for Payer: NaphCare Correctional Healthcare |
$31,432.54
|
|
|
Other Peripheral Vascular Procedures
|
Facility
|
IP
|
$17,569.37
|
|
|
Service Code
|
APR-DRG 1823
|
| Hospital Charge Code |
APRDRG1821
|
| Min. Negotiated Rate |
$17,569.37 |
| Max. Negotiated Rate |
$17,569.37 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,569.37
|
| Rate for Payer: Mercy Care Medicaid |
$17,569.37
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,569.37
|
|
