|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$4,103.19
|
|
|
Service Code
|
APR-DRG 2411
|
| Hospital Charge Code |
APRDRG2411
|
| Min. Negotiated Rate |
$4,103.19 |
| Max. Negotiated Rate |
$4,103.19 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,103.19
|
| Rate for Payer: Mercy Care Medicaid |
$4,103.19
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,103.19
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$16,030.50
|
|
|
Service Code
|
APR-DRG 2414
|
| Hospital Charge Code |
APRDRG2413
|
| Min. Negotiated Rate |
$16,030.50 |
| Max. Negotiated Rate |
$16,030.50 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,030.50
|
| Rate for Payer: Mercy Care Medicaid |
$16,030.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,030.50
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,366.80
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$5,002.38
|
|
|
Service Code
|
APR-DRG 2412
|
| Hospital Charge Code |
APRDRG2412
|
| Min. Negotiated Rate |
$5,002.38 |
| Max. Negotiated Rate |
$5,002.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,002.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,002.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,002.38
|
|
|
Peptic Ulcer And Gastritis
|
Facility
|
IP
|
$7,366.80
|
|
|
Service Code
|
APR-DRG 2413
|
| Hospital Charge Code |
APRDRG2414
|
| Min. Negotiated Rate |
$7,366.80 |
| Max. Negotiated Rate |
$7,366.80 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,366.80
|
| Rate for Payer: Mercy Care Medicaid |
$7,366.80
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,366.80
|
|
|
PERCUTANEOUS 18GA ACCESS NEEDLE
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
22354210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.96
|
| Rate for Payer: Banner UC Health Medicare |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.96
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.96
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of AZ Commercial |
$56.70
|
| Rate for Payer: Devoted Health Medicare |
$14.58
|
| Rate for Payer: Humana of AZ Medicare |
$12.96
|
| Rate for Payer: Southwest Service Administrators UFCW |
$55.08
|
| Rate for Payer: TriWest Medicare |
$12.96
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
| Rate for Payer: United Healthcare Medicare |
$12.96
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.83
|
|
|
PERCUTANEOUS 18GA ACCESS NEEDLE
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
22354210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of AZ Commercial |
$72.90
|
| Rate for Payer: Cash Price |
$64.80
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,318.54
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$53,318.54 |
| Max. Negotiated Rate |
$53,318.54 |
| Rate for Payer: Seven Corners Travel Insurance |
$53,318.54
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$42,542.41
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$42,542.41 |
| Max. Negotiated Rate |
$42,542.41 |
| Rate for Payer: Seven Corners Travel Insurance |
$42,542.41
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$12,050.75
|
|
|
Service Code
|
APR-DRG 1741
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$12,050.75 |
| Max. Negotiated Rate |
$12,050.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,050.75
|
| Rate for Payer: Mercy Care Medicaid |
$12,050.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,050.75
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$13,351.15
|
|
|
Service Code
|
APR-DRG 1742
|
| Hospital Charge Code |
APRDRG1741
|
| Min. Negotiated Rate |
$13,351.15 |
| Max. Negotiated Rate |
$13,351.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,351.15
|
| Rate for Payer: Mercy Care Medicaid |
$13,351.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,351.15
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$12,050.75
|
|
|
Service Code
|
APR-DRG 1741
|
| Hospital Charge Code |
APRDRG1741
|
| Min. Negotiated Rate |
$12,050.75 |
| Max. Negotiated Rate |
$12,050.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,050.75
|
| Rate for Payer: Mercy Care Medicaid |
$12,050.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,050.75
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1743
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1741
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$13,351.15
|
|
|
Service Code
|
APR-DRG 1742
|
| Hospital Charge Code |
APRDRG1743
|
| Min. Negotiated Rate |
$13,351.15 |
| Max. Negotiated Rate |
$13,351.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,351.15
|
| Rate for Payer: Mercy Care Medicaid |
$13,351.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,351.15
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$17,279.69
|
|
|
Service Code
|
APR-DRG 1743
|
| Hospital Charge Code |
APRDRG1744
|
| Min. Negotiated Rate |
$17,279.69 |
| Max. Negotiated Rate |
$17,279.69 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,279.69
|
| Rate for Payer: Mercy Care Medicaid |
$17,279.69
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,279.69
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$25,371.74
|
|
|
Service Code
|
APR-DRG 1744
|
| Hospital Charge Code |
APRDRG1741
|
| Min. Negotiated Rate |
$25,371.74 |
| Max. Negotiated Rate |
$25,371.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$25,371.74
|
| Rate for Payer: Mercy Care Medicaid |
$25,371.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$25,371.74
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$12,050.75
|
|
|
Service Code
|
APR-DRG 1741
|
| Hospital Charge Code |
APRDRG1743
|
| Min. Negotiated Rate |
$12,050.75 |
| Max. Negotiated Rate |
$12,050.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,050.75
|
| Rate for Payer: Mercy Care Medicaid |
$12,050.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,050.75
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$25,371.74
|
|
|
Service Code
|
APR-DRG 1744
|
| Hospital Charge Code |
APRDRG1744
|
| Min. Negotiated Rate |
$25,371.74 |
| Max. Negotiated Rate |
$25,371.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$25,371.74
|
| Rate for Payer: Mercy Care Medicaid |
$25,371.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$25,371.74
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$13,351.15
|
|
|
Service Code
|
APR-DRG 1742
|
| Hospital Charge Code |
APRDRG1744
|
| Min. Negotiated Rate |
$13,351.15 |
| Max. Negotiated Rate |
$13,351.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,351.15
|
| Rate for Payer: Mercy Care Medicaid |
$13,351.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,351.15
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$13,351.15
|
|
|
Service Code
|
APR-DRG 1742
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$13,351.15 |
| Max. Negotiated Rate |
$13,351.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$13,351.15
|
| Rate for Payer: Mercy Care Medicaid |
$13,351.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$13,351.15
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$12,050.75
|
|
|
Service Code
|
APR-DRG 1741
|
| Hospital Charge Code |
APRDRG1744
|
| Min. Negotiated Rate |
$12,050.75 |
| Max. Negotiated Rate |
$12,050.75 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,050.75
|
| Rate for Payer: Mercy Care Medicaid |
$12,050.75
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,050.75
|
|
|
Percutaneous Cardiac Intervention With Ami
|
Facility
|
IP
|
$25,371.74
|
|
|
Service Code
|
APR-DRG 1744
|
| Hospital Charge Code |
APRDRG1742
|
| Min. Negotiated Rate |
$25,371.74 |
| Max. Negotiated Rate |
$25,371.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$25,371.74
|
| Rate for Payer: Mercy Care Medicaid |
$25,371.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$25,371.74
|
|
