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All Charges

Charge

Type

Setting

Price

Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed

Facility

OP

$9,860.74

Service Code	CPT 64561
Hospital Revenue Code	490
Min. Negotiated Rate	$418.76
Max. Negotiated Rate	$9,860.74
Rate for Payer: Banner UC Health Medicare	$4,282.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$418.76
Rate for Payer: Mercy Care Medicaid	$418.76
Rate for Payer: NaphCare Correctional Healthcare	$4,282.94
Rate for Payer: Seven Corners Travel Insurance	$9,860.74
Rate for Payer: United Healthcare Commercial	$6,508.00

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$13,076.90

Service Code	APR-DRG 0301
Hospital Charge Code	APRDRG0304
Min. Negotiated Rate	$13,076.90
Max. Negotiated Rate	$13,076.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,076.90
Rate for Payer: Mercy Care Medicaid	$13,076.90
Rate for Payer: NaphCare Correctional Healthcare	$13,076.90

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$18,696.52

Service Code	APR-DRG 0302
Hospital Charge Code	APRDRG0304
Min. Negotiated Rate	$18,696.52
Max. Negotiated Rate	$18,696.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,696.52
Rate for Payer: Mercy Care Medicaid	$18,696.52
Rate for Payer: NaphCare Correctional Healthcare	$18,696.52

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$36,903.46

Service Code	APR-DRG 0304
Hospital Charge Code	APRDRG0302
Min. Negotiated Rate	$36,903.46
Max. Negotiated Rate	$36,903.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36,903.46
Rate for Payer: Mercy Care Medicaid	$36,903.46
Rate for Payer: NaphCare Correctional Healthcare	$36,903.46

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$18,696.52

Service Code	APR-DRG 0302
Hospital Charge Code	APRDRG0302
Min. Negotiated Rate	$18,696.52
Max. Negotiated Rate	$18,696.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,696.52
Rate for Payer: Mercy Care Medicaid	$18,696.52
Rate for Payer: NaphCare Correctional Healthcare	$18,696.52

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$13,076.90

Service Code	APR-DRG 0301
Hospital Charge Code	APRDRG0303
Min. Negotiated Rate	$13,076.90
Max. Negotiated Rate	$13,076.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,076.90
Rate for Payer: Mercy Care Medicaid	$13,076.90
Rate for Payer: NaphCare Correctional Healthcare	$13,076.90

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$26,175.55

Service Code	APR-DRG 0303
Hospital Charge Code	APRDRG0304
Min. Negotiated Rate	$26,175.55
Max. Negotiated Rate	$26,175.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,175.55
Rate for Payer: Mercy Care Medicaid	$26,175.55
Rate for Payer: NaphCare Correctional Healthcare	$26,175.55

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$26,175.55

Service Code	APR-DRG 0303
Hospital Charge Code	APRDRG0301
Min. Negotiated Rate	$26,175.55
Max. Negotiated Rate	$26,175.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,175.55
Rate for Payer: Mercy Care Medicaid	$26,175.55
Rate for Payer: NaphCare Correctional Healthcare	$26,175.55

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$26,175.55

Service Code	APR-DRG 0303
Hospital Charge Code	APRDRG0303
Min. Negotiated Rate	$26,175.55
Max. Negotiated Rate	$26,175.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,175.55
Rate for Payer: Mercy Care Medicaid	$26,175.55
Rate for Payer: NaphCare Correctional Healthcare	$26,175.55

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$36,903.46

Service Code	APR-DRG 0304
Hospital Charge Code	APRDRG0303
Min. Negotiated Rate	$36,903.46
Max. Negotiated Rate	$36,903.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36,903.46
Rate for Payer: Mercy Care Medicaid	$36,903.46
Rate for Payer: NaphCare Correctional Healthcare	$36,903.46

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$26,175.55

Service Code	APR-DRG 0303
Hospital Charge Code	APRDRG0302
Min. Negotiated Rate	$26,175.55
Max. Negotiated Rate	$26,175.55
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,175.55
Rate for Payer: Mercy Care Medicaid	$26,175.55
Rate for Payer: NaphCare Correctional Healthcare	$26,175.55

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$13,076.90

Service Code	APR-DRG 0301
Hospital Charge Code	APRDRG0302
Min. Negotiated Rate	$13,076.90
Max. Negotiated Rate	$13,076.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,076.90
Rate for Payer: Mercy Care Medicaid	$13,076.90
Rate for Payer: NaphCare Correctional Healthcare	$13,076.90

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$36,903.46

Service Code	APR-DRG 0304
Hospital Charge Code	APRDRG0301
Min. Negotiated Rate	$36,903.46
Max. Negotiated Rate	$36,903.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36,903.46
Rate for Payer: Mercy Care Medicaid	$36,903.46
Rate for Payer: NaphCare Correctional Healthcare	$36,903.46

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$36,903.46

Service Code	APR-DRG 0304
Hospital Charge Code	APRDRG0304
Min. Negotiated Rate	$36,903.46
Max. Negotiated Rate	$36,903.46
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$36,903.46
Rate for Payer: Mercy Care Medicaid	$36,903.46
Rate for Payer: NaphCare Correctional Healthcare	$36,903.46

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$13,076.90

Service Code	APR-DRG 0301
Hospital Charge Code	APRDRG0301
Min. Negotiated Rate	$13,076.90
Max. Negotiated Rate	$13,076.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,076.90
Rate for Payer: Mercy Care Medicaid	$13,076.90
Rate for Payer: NaphCare Correctional Healthcare	$13,076.90

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$18,696.52

Service Code	APR-DRG 0302
Hospital Charge Code	APRDRG0303
Min. Negotiated Rate	$18,696.52
Max. Negotiated Rate	$18,696.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,696.52
Rate for Payer: Mercy Care Medicaid	$18,696.52
Rate for Payer: NaphCare Correctional Healthcare	$18,696.52

Percutaneous Intracranial And Extracranial Vascular Procedures

Facility

IP

$18,696.52

Service Code	APR-DRG 0302
Hospital Charge Code	APRDRG0301
Min. Negotiated Rate	$18,696.52
Max. Negotiated Rate	$18,696.52
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,696.52
Rate for Payer: Mercy Care Medicaid	$18,696.52
Rate for Payer: NaphCare Correctional Healthcare	$18,696.52

PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE PHALANX OR PHALANGES

Facility

IP

$1,185.00

Service Code	CPT 28496
Hospital Charge Code	24043336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,066.50
Max. Negotiated Rate	$1,066.50
Rate for Payer: Aetna of AZ Commercial	$1,066.50
Rate for Payer: Cash Price	$948.00

PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE PHALANX OR PHALANGES

Facility

OP

$1,185.00

Service Code	CPT 28496
Hospital Charge Code	24043336
Hospital Revenue Code	360
Min. Negotiated Rate	$187.70
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,066.50
Rate for Payer: Arizona Complete Health Allwell	$189.60
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$805.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$225.94
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$189.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$189.60
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cigna of AZ Commercial	$592.50
Rate for Payer: Devoted Health Medicare	$213.30
Rate for Payer: Humana of AZ Medicare	$189.60
Rate for Payer: Mercy Care Medicaid	$225.94
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	$805.80
Rate for Payer: TriWest Medicare	$189.60
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$189.60
Rate for Payer: Veterans Affairs TRICARE	$187.70

PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE WITH MANIPULATION EACH - Tech

Facility

IP

$1,704.00

Service Code	CPT 28476
Hospital Charge Code	24043299
Hospital Revenue Code	360
Min. Negotiated Rate	$1,533.60
Max. Negotiated Rate	$1,533.60
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Cash Price	$1,363.20

PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE WITH MANIPULATION EACH - Tech

Facility

OP

$1,704.00

Service Code	CPT 28476
Hospital Charge Code	24043299
Hospital Revenue Code	360
Min. Negotiated Rate	$269.91
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,533.60
Rate for Payer: Arizona Complete Health Allwell	$272.64
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,158.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$272.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$272.64
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cigna of AZ Commercial	$852.00
Rate for Payer: Devoted Health Medicare	$306.72
Rate for Payer: Humana of AZ Medicare	$272.64
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	$1,158.72
Rate for Payer: TriWest Medicare	$272.64
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$272.64
Rate for Payer: Veterans Affairs TRICARE	$269.91

Percutaneous Structural Cardiac Procedures

Facility

IP

$26,889.57

Service Code	APR-DRG 1831
Hospital Charge Code	APRDRG1831
Min. Negotiated Rate	$26,889.57
Max. Negotiated Rate	$26,889.57
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,889.57
Rate for Payer: Mercy Care Medicaid	$26,889.57
Rate for Payer: NaphCare Correctional Healthcare	$26,889.57

Percutaneous Structural Cardiac Procedures

Facility

IP

$48,903.71

Service Code	APR-DRG 1834
Hospital Charge Code	APRDRG1832
Min. Negotiated Rate	$48,903.71
Max. Negotiated Rate	$48,903.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$48,903.71
Rate for Payer: Mercy Care Medicaid	$48,903.71
Rate for Payer: NaphCare Correctional Healthcare	$48,903.71

Percutaneous Structural Cardiac Procedures

Facility

IP

$33,632.13

Service Code	APR-DRG 1833
Hospital Charge Code	APRDRG1832
Min. Negotiated Rate	$33,632.13
Max. Negotiated Rate	$33,632.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,632.13
Rate for Payer: Mercy Care Medicaid	$33,632.13
Rate for Payer: NaphCare Correctional Healthcare	$33,632.13

Percutaneous Structural Cardiac Procedures

Facility

IP

$26,889.57

Service Code	APR-DRG 1831
Hospital Charge Code	APRDRG1833
Min. Negotiated Rate	$26,889.57
Max. Negotiated Rate	$26,889.57
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26,889.57
Rate for Payer: Mercy Care Medicaid	$26,889.57
Rate for Payer: NaphCare Correctional Healthcare	$26,889.57

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