|
Other Pneumonia
|
Facility
|
IP
|
$5,743.76
|
|
|
Service Code
|
APR-DRG 1393
|
| Hospital Charge Code |
APRDRG1394
|
| Min. Negotiated Rate |
$5,743.76 |
| Max. Negotiated Rate |
$5,743.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,743.76
|
| Rate for Payer: Mercy Care Medicaid |
$5,743.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,743.76
|
|
|
Other Pneumonia
|
Facility
|
IP
|
$9,200.97
|
|
|
Service Code
|
APR-DRG 1394
|
| Hospital Charge Code |
APRDRG1394
|
| Min. Negotiated Rate |
$9,200.97 |
| Max. Negotiated Rate |
$9,200.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,200.97
|
| Rate for Payer: Mercy Care Medicaid |
$9,200.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,200.97
|
|
|
Other Pneumonia
|
Facility
|
IP
|
$5,743.76
|
|
|
Service Code
|
APR-DRG 1393
|
| Hospital Charge Code |
APRDRG1392
|
| Min. Negotiated Rate |
$5,743.76 |
| Max. Negotiated Rate |
$5,743.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,743.76
|
| Rate for Payer: Mercy Care Medicaid |
$5,743.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,743.76
|
|
|
OTHER PROCEDURE ON LIVER USING AN ENDOSCOPE
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
28131051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$9,354.07 |
| Rate for Payer: Aetna of AZ Commercial |
$1,470.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$261.44
|
| Rate for Payer: Banner UC Health Medicare |
$261.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,111.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$261.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$261.44
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cigna of AZ Commercial |
$817.00
|
| Rate for Payer: Devoted Health Medicare |
$294.12
|
| Rate for Payer: Humana of AZ Medicare |
$261.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$9,354.07
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,111.12
|
| Rate for Payer: TriWest Medicare |
$261.44
|
| Rate for Payer: United Healthcare Commercial |
$5,611.00
|
| Rate for Payer: United Healthcare Medicare |
$261.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$258.83
|
|
|
OTHER PROCEDURE ON LIVER USING AN ENDOSCOPE
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
28131051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,470.60 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Aetna of AZ Commercial |
$1,470.60
|
| Rate for Payer: Cash Price |
$1,307.20
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$10,736.33
|
|
|
Service Code
|
APR-DRG 4052
|
| Hospital Charge Code |
APRDRG4054
|
| Min. Negotiated Rate |
$10,736.33 |
| Max. Negotiated Rate |
$10,736.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,736.33
|
| Rate for Payer: Mercy Care Medicaid |
$10,736.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,736.33
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$35,614.99
|
|
|
Service Code
|
APR-DRG 4054
|
| Hospital Charge Code |
APRDRG4054
|
| Min. Negotiated Rate |
$35,614.99 |
| Max. Negotiated Rate |
$35,614.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,614.99
|
| Rate for Payer: Mercy Care Medicaid |
$35,614.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,614.99
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$9,049.46
|
|
|
Service Code
|
APR-DRG 4051
|
| Hospital Charge Code |
APRDRG4052
|
| Min. Negotiated Rate |
$9,049.46 |
| Max. Negotiated Rate |
$9,049.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,049.46
|
| Rate for Payer: Mercy Care Medicaid |
$9,049.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,049.46
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$16,158.15
|
|
|
Service Code
|
APR-DRG 4053
|
| Hospital Charge Code |
APRDRG4053
|
| Min. Negotiated Rate |
$16,158.15 |
| Max. Negotiated Rate |
$16,158.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,158.15
|
| Rate for Payer: Mercy Care Medicaid |
$16,158.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,158.15
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$16,158.15
|
|
|
Service Code
|
APR-DRG 4053
|
| Hospital Charge Code |
APRDRG4051
|
| Min. Negotiated Rate |
$16,158.15 |
| Max. Negotiated Rate |
$16,158.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,158.15
|
| Rate for Payer: Mercy Care Medicaid |
$16,158.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,158.15
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$35,614.99
|
|
|
Service Code
|
APR-DRG 4054
|
| Hospital Charge Code |
APRDRG4051
|
| Min. Negotiated Rate |
$35,614.99 |
| Max. Negotiated Rate |
$35,614.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,614.99
|
| Rate for Payer: Mercy Care Medicaid |
$35,614.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,614.99
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$9,049.46
|
|
|
Service Code
|
APR-DRG 4051
|
| Hospital Charge Code |
APRDRG4051
|
| Min. Negotiated Rate |
$9,049.46 |
| Max. Negotiated Rate |
$9,049.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,049.46
|
| Rate for Payer: Mercy Care Medicaid |
$9,049.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,049.46
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$16,158.15
|
|
|
Service Code
|
APR-DRG 4053
|
| Hospital Charge Code |
APRDRG4052
|
| Min. Negotiated Rate |
$16,158.15 |
| Max. Negotiated Rate |
$16,158.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,158.15
|
| Rate for Payer: Mercy Care Medicaid |
$16,158.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,158.15
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$35,614.99
|
|
|
Service Code
|
APR-DRG 4054
|
| Hospital Charge Code |
APRDRG4052
|
| Min. Negotiated Rate |
$35,614.99 |
| Max. Negotiated Rate |
$35,614.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,614.99
|
| Rate for Payer: Mercy Care Medicaid |
$35,614.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,614.99
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$10,736.33
|
|
|
Service Code
|
APR-DRG 4052
|
| Hospital Charge Code |
APRDRG4051
|
| Min. Negotiated Rate |
$10,736.33 |
| Max. Negotiated Rate |
$10,736.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,736.33
|
| Rate for Payer: Mercy Care Medicaid |
$10,736.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,736.33
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$9,049.46
|
|
|
Service Code
|
APR-DRG 4051
|
| Hospital Charge Code |
APRDRG4053
|
| Min. Negotiated Rate |
$9,049.46 |
| Max. Negotiated Rate |
$9,049.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,049.46
|
| Rate for Payer: Mercy Care Medicaid |
$9,049.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,049.46
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$10,736.33
|
|
|
Service Code
|
APR-DRG 4052
|
| Hospital Charge Code |
APRDRG4053
|
| Min. Negotiated Rate |
$10,736.33 |
| Max. Negotiated Rate |
$10,736.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,736.33
|
| Rate for Payer: Mercy Care Medicaid |
$10,736.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,736.33
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$10,736.33
|
|
|
Service Code
|
APR-DRG 4052
|
| Hospital Charge Code |
APRDRG4052
|
| Min. Negotiated Rate |
$10,736.33 |
| Max. Negotiated Rate |
$10,736.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,736.33
|
| Rate for Payer: Mercy Care Medicaid |
$10,736.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,736.33
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$16,158.15
|
|
|
Service Code
|
APR-DRG 4053
|
| Hospital Charge Code |
APRDRG4054
|
| Min. Negotiated Rate |
$16,158.15 |
| Max. Negotiated Rate |
$16,158.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,158.15
|
| Rate for Payer: Mercy Care Medicaid |
$16,158.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,158.15
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$9,049.46
|
|
|
Service Code
|
APR-DRG 4051
|
| Hospital Charge Code |
APRDRG4054
|
| Min. Negotiated Rate |
$9,049.46 |
| Max. Negotiated Rate |
$9,049.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,049.46
|
| Rate for Payer: Mercy Care Medicaid |
$9,049.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,049.46
|
|
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
Facility
|
IP
|
$35,614.99
|
|
|
Service Code
|
APR-DRG 4054
|
| Hospital Charge Code |
APRDRG4053
|
| Min. Negotiated Rate |
$35,614.99 |
| Max. Negotiated Rate |
$35,614.99 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,614.99
|
| Rate for Payer: Mercy Care Medicaid |
$35,614.99
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,614.99
|
|
|
Other Procedures Of Blood And Blood-Forming Organs
|
Facility
|
IP
|
$46,387.79
|
|
|
Service Code
|
APR-DRG 6514
|
| Hospital Charge Code |
APRDRG6511
|
| Min. Negotiated Rate |
$46,387.79 |
| Max. Negotiated Rate |
$46,387.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$46,387.79
|
| Rate for Payer: Mercy Care Medicaid |
$46,387.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$46,387.79
|
|
|
Other Procedures Of Blood And Blood-Forming Organs
|
Facility
|
IP
|
$9,886.93
|
|
|
Service Code
|
APR-DRG 6512
|
| Hospital Charge Code |
APRDRG6514
|
| Min. Negotiated Rate |
$9,886.93 |
| Max. Negotiated Rate |
$9,886.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,886.93
|
| Rate for Payer: Mercy Care Medicaid |
$9,886.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,886.93
|
|
|
Other Procedures Of Blood And Blood-Forming Organs
|
Facility
|
IP
|
$9,886.93
|
|
|
Service Code
|
APR-DRG 6512
|
| Hospital Charge Code |
APRDRG6511
|
| Min. Negotiated Rate |
$9,886.93 |
| Max. Negotiated Rate |
$9,886.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,886.93
|
| Rate for Payer: Mercy Care Medicaid |
$9,886.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,886.93
|
|
|
Other Procedures Of Blood And Blood-Forming Organs
|
Facility
|
IP
|
$17,262.16
|
|
|
Service Code
|
APR-DRG 6513
|
| Hospital Charge Code |
APRDRG6511
|
| Min. Negotiated Rate |
$17,262.16 |
| Max. Negotiated Rate |
$17,262.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,262.16
|
| Rate for Payer: Mercy Care Medicaid |
$17,262.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,262.16
|
|
