|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - 28124
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
24043292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,459.80 |
| Max. Negotiated Rate |
$1,459.80 |
| Rate for Payer: Aetna of AZ Commercial |
$1,459.80
|
| Rate for Payer: Cash Price |
$1,297.60
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - 28124
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
24043292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.07 |
| Max. Negotiated Rate |
$5,062.66 |
| Rate for Payer: Aetna of AZ Commercial |
$1,459.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$259.52
|
| Rate for Payer: Banner UC Health Medicare |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,102.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$138.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$259.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$259.52
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cigna of AZ Commercial |
$811.00
|
| Rate for Payer: Devoted Health Medicare |
$291.96
|
| Rate for Payer: Humana of AZ Medicare |
$259.52
|
| Rate for Payer: Mercy Care Medicaid |
$138.07
|
| Rate for Payer: NaphCare Correctional Healthcare |
$162.54
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,062.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,102.96
|
| Rate for Payer: TriWest Medicare |
$259.52
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$259.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$256.92
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - Tech
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
24043309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,078.10 |
| Max. Negotiated Rate |
$2,078.10 |
| Rate for Payer: Aetna of AZ Commercial |
$2,078.10
|
| Rate for Payer: Cash Price |
$1,847.20
|
|
|
PARTIAL EXCISION (CRATERIZATION SAUCERIZATION SEQUESTRECTOMY - Tech
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
24043309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.46 |
| Max. Negotiated Rate |
$5,062.66 |
| Rate for Payer: Aetna of AZ Commercial |
$2,078.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$369.44
|
| Rate for Payer: Banner UC Health Medicare |
$1,062.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,570.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$169.46
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$369.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$369.44
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cigna of AZ Commercial |
$1,154.50
|
| Rate for Payer: Devoted Health Medicare |
$415.62
|
| Rate for Payer: Humana of AZ Medicare |
$369.44
|
| Rate for Payer: Mercy Care Medicaid |
$169.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,062.88
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,062.66
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,570.12
|
| Rate for Payer: TriWest Medicare |
$369.44
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$369.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$365.75
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$3,100.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Hospital Charge Code |
APRDRG8441
|
| Min. Negotiated Rate |
$3,100.89 |
| Max. Negotiated Rate |
$3,100.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.89
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.89
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$8,655.28
|
|
|
Service Code
|
APR-DRG 8443
|
| Hospital Charge Code |
APRDRG8444
|
| Min. Negotiated Rate |
$8,655.28 |
| Max. Negotiated Rate |
$8,655.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,655.28
|
| Rate for Payer: Mercy Care Medicaid |
$8,655.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,655.28
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$5,268.92
|
|
|
Service Code
|
APR-DRG 8442
|
| Hospital Charge Code |
APRDRG8443
|
| Min. Negotiated Rate |
$5,268.92 |
| Max. Negotiated Rate |
$5,268.92 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,268.92
|
| Rate for Payer: Mercy Care Medicaid |
$5,268.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,268.92
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$19,419.66
|
|
|
Service Code
|
APR-DRG 8444
|
| Hospital Charge Code |
APRDRG8443
|
| Min. Negotiated Rate |
$19,419.66 |
| Max. Negotiated Rate |
$19,419.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,419.66
|
| Rate for Payer: Mercy Care Medicaid |
$19,419.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,419.66
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$8,655.28
|
|
|
Service Code
|
APR-DRG 8443
|
| Hospital Charge Code |
APRDRG8442
|
| Min. Negotiated Rate |
$8,655.28 |
| Max. Negotiated Rate |
$8,655.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,655.28
|
| Rate for Payer: Mercy Care Medicaid |
$8,655.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,655.28
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$3,100.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Hospital Charge Code |
APRDRG8442
|
| Min. Negotiated Rate |
$3,100.89 |
| Max. Negotiated Rate |
$3,100.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.89
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.89
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$19,419.66
|
|
|
Service Code
|
APR-DRG 8444
|
| Hospital Charge Code |
APRDRG8441
|
| Min. Negotiated Rate |
$19,419.66 |
| Max. Negotiated Rate |
$19,419.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,419.66
|
| Rate for Payer: Mercy Care Medicaid |
$19,419.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,419.66
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$19,419.66
|
|
|
Service Code
|
APR-DRG 8444
|
| Hospital Charge Code |
APRDRG8444
|
| Min. Negotiated Rate |
$19,419.66 |
| Max. Negotiated Rate |
$19,419.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,419.66
|
| Rate for Payer: Mercy Care Medicaid |
$19,419.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,419.66
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$19,419.66
|
|
|
Service Code
|
APR-DRG 8444
|
| Hospital Charge Code |
APRDRG8442
|
| Min. Negotiated Rate |
$19,419.66 |
| Max. Negotiated Rate |
$19,419.66 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,419.66
|
| Rate for Payer: Mercy Care Medicaid |
$19,419.66
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,419.66
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$5,268.92
|
|
|
Service Code
|
APR-DRG 8442
|
| Hospital Charge Code |
APRDRG8444
|
| Min. Negotiated Rate |
$5,268.92 |
| Max. Negotiated Rate |
$5,268.92 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,268.92
|
| Rate for Payer: Mercy Care Medicaid |
$5,268.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,268.92
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$5,268.92
|
|
|
Service Code
|
APR-DRG 8442
|
| Hospital Charge Code |
APRDRG8441
|
| Min. Negotiated Rate |
$5,268.92 |
| Max. Negotiated Rate |
$5,268.92 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,268.92
|
| Rate for Payer: Mercy Care Medicaid |
$5,268.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,268.92
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$3,100.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Hospital Charge Code |
APRDRG8444
|
| Min. Negotiated Rate |
$3,100.89 |
| Max. Negotiated Rate |
$3,100.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.89
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.89
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$3,100.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Hospital Charge Code |
APRDRG8443
|
| Min. Negotiated Rate |
$3,100.89 |
| Max. Negotiated Rate |
$3,100.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,100.89
|
| Rate for Payer: Mercy Care Medicaid |
$3,100.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,100.89
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$8,655.28
|
|
|
Service Code
|
APR-DRG 8443
|
| Hospital Charge Code |
APRDRG8443
|
| Min. Negotiated Rate |
$8,655.28 |
| Max. Negotiated Rate |
$8,655.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,655.28
|
| Rate for Payer: Mercy Care Medicaid |
$8,655.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,655.28
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$8,655.28
|
|
|
Service Code
|
APR-DRG 8443
|
| Hospital Charge Code |
APRDRG8441
|
| Min. Negotiated Rate |
$8,655.28 |
| Max. Negotiated Rate |
$8,655.28 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,655.28
|
| Rate for Payer: Mercy Care Medicaid |
$8,655.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,655.28
|
|
|
Partial Thickness Burns Without Skin Graft
|
Facility
|
IP
|
$5,268.92
|
|
|
Service Code
|
APR-DRG 8442
|
| Hospital Charge Code |
APRDRG8442
|
| Min. Negotiated Rate |
$5,268.92 |
| Max. Negotiated Rate |
$5,268.92 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,268.92
|
| Rate for Payer: Mercy Care Medicaid |
$5,268.92
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,268.92
|
|
|
Partial Thromboplastin Time
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of AZ Commercial |
$121.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$21.60
|
| Rate for Payer: Banner UC Health Medicare |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$21.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$21.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of AZ Commercial |
$87.75
|
| Rate for Payer: Devoted Health Medicare |
$24.30
|
| Rate for Payer: Humana of AZ Medicare |
$21.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$8.71
|
| Rate for Payer: Southwest Service Administrators UFCW |
$91.80
|
| Rate for Payer: TriWest Medicare |
$21.60
|
| Rate for Payer: United Healthcare Commercial |
$77.22
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$21.38
|
|
|
Partial Thromboplastin Time
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of AZ Commercial |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
|
|
.PARVOVIR IGM
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
22481449
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of AZ Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$140.80
|
|
|
.PARVOVIR IGM
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
22481449
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of AZ Commercial |
$158.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$28.16
|
| Rate for Payer: Banner UC Health Medicare |
$28.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$119.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$28.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$28.16
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cigna of AZ Commercial |
$114.40
|
| Rate for Payer: Devoted Health Medicare |
$31.68
|
| Rate for Payer: Humana of AZ Medicare |
$28.16
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.79
|
| Rate for Payer: Southwest Service Administrators UFCW |
$119.68
|
| Rate for Payer: TriWest Medicare |
$28.16
|
| Rate for Payer: United Healthcare Commercial |
$100.67
|
| Rate for Payer: United Healthcare Medicare |
$28.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$27.88
|
|
|
Parvovirus B19, Human, IgG/IgM LC
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
2269428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of AZ Commercial |
$165.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$29.44
|
| Rate for Payer: Banner UC Health Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$29.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$29.44
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cigna of AZ Commercial |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$33.12
|
| Rate for Payer: Humana of AZ Medicare |
$29.44
|
| Rate for Payer: Seven Corners Travel Insurance |
$21.79
|
| Rate for Payer: Southwest Service Administrators UFCW |
$125.12
|
| Rate for Payer: TriWest Medicare |
$29.44
|
| Rate for Payer: United Healthcare Commercial |
$105.25
|
| Rate for Payer: United Healthcare Medicare |
$29.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$29.15
|
|
