|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$2,447.89
|
|
|
Service Code
|
APR-DRG 5481
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$2,447.89 |
| Max. Negotiated Rate |
$2,447.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,447.89
|
| Rate for Payer: Mercy Care Medicaid |
$2,447.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,447.89
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$10,381.42
|
|
|
Service Code
|
APR-DRG 5483
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$10,381.42 |
| Max. Negotiated Rate |
$10,381.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,381.42
|
| Rate for Payer: Mercy Care Medicaid |
$10,381.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,381.42
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$32,425.02
|
|
|
Service Code
|
APR-DRG 5484
|
| Hospital Charge Code |
APRDRG5484
|
| Min. Negotiated Rate |
$32,425.02 |
| Max. Negotiated Rate |
$32,425.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,425.02
|
| Rate for Payer: Mercy Care Medicaid |
$32,425.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,425.02
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$10,381.42
|
|
|
Service Code
|
APR-DRG 5483
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$10,381.42 |
| Max. Negotiated Rate |
$10,381.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,381.42
|
| Rate for Payer: Mercy Care Medicaid |
$10,381.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,381.42
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$10,381.42
|
|
|
Service Code
|
APR-DRG 5483
|
| Hospital Charge Code |
APRDRG5483
|
| Min. Negotiated Rate |
$10,381.42 |
| Max. Negotiated Rate |
$10,381.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,381.42
|
| Rate for Payer: Mercy Care Medicaid |
$10,381.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,381.42
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$32,425.02
|
|
|
Service Code
|
APR-DRG 5484
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$32,425.02 |
| Max. Negotiated Rate |
$32,425.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,425.02
|
| Rate for Payer: Mercy Care Medicaid |
$32,425.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,425.02
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$10,381.42
|
|
|
Service Code
|
APR-DRG 5483
|
| Hospital Charge Code |
APRDRG5484
|
| Min. Negotiated Rate |
$10,381.42 |
| Max. Negotiated Rate |
$10,381.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,381.42
|
| Rate for Payer: Mercy Care Medicaid |
$10,381.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,381.42
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$32,425.02
|
|
|
Service Code
|
APR-DRG 5484
|
| Hospital Charge Code |
APRDRG5483
|
| Min. Negotiated Rate |
$32,425.02 |
| Max. Negotiated Rate |
$32,425.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,425.02
|
| Rate for Payer: Mercy Care Medicaid |
$32,425.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,425.02
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$32,425.02
|
|
|
Service Code
|
APR-DRG 5484
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$32,425.02 |
| Max. Negotiated Rate |
$32,425.02 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$32,425.02
|
| Rate for Payer: Mercy Care Medicaid |
$32,425.02
|
| Rate for Payer: NaphCare Correctional Healthcare |
$32,425.02
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5484
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5482
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$2,447.89
|
|
|
Service Code
|
APR-DRG 5481
|
| Hospital Charge Code |
APRDRG5481
|
| Min. Negotiated Rate |
$2,447.89 |
| Max. Negotiated Rate |
$2,447.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,447.89
|
| Rate for Payer: Mercy Care Medicaid |
$2,447.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,447.89
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$5,311.70
|
|
|
Service Code
|
APR-DRG 5482
|
| Hospital Charge Code |
APRDRG5483
|
| Min. Negotiated Rate |
$5,311.70 |
| Max. Negotiated Rate |
$5,311.70 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,311.70
|
| Rate for Payer: Mercy Care Medicaid |
$5,311.70
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,311.70
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$2,447.89
|
|
|
Service Code
|
APR-DRG 5481
|
| Hospital Charge Code |
APRDRG5484
|
| Min. Negotiated Rate |
$2,447.89 |
| Max. Negotiated Rate |
$2,447.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,447.89
|
| Rate for Payer: Mercy Care Medicaid |
$2,447.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,447.89
|
|
|
Postpartum And Post Abortion Diagnosis With O.R. Procedure
|
Facility
|
IP
|
$2,447.89
|
|
|
Service Code
|
APR-DRG 5481
|
| Hospital Charge Code |
APRDRG5483
|
| Min. Negotiated Rate |
$2,447.89 |
| Max. Negotiated Rate |
$2,447.89 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,447.89
|
| Rate for Payer: Mercy Care Medicaid |
$2,447.89
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,447.89
|
|
|
Potassium 24 hr urine
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$53.60
|
|
|
Potassium 24 hr urine
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of AZ Commercial |
$60.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$10.72
|
| Rate for Payer: Banner UC Health Medicare |
$10.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$45.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$10.72
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$10.72
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cigna of AZ Commercial |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$12.06
|
| Rate for Payer: Humana of AZ Medicare |
$10.72
|
| Rate for Payer: Seven Corners Travel Insurance |
$6.86
|
| Rate for Payer: Southwest Service Administrators UFCW |
$45.56
|
| Rate for Payer: TriWest Medicare |
$10.72
|
| Rate for Payer: United Healthcare Commercial |
$38.32
|
| Rate for Payer: United Healthcare Medicare |
$10.72
|
| Rate for Payer: Veterans Affairs TRICARE |
$10.61
|
|
|
potassium 25 mEq (bicarbonate, effervescence tab) [CQCH]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 245532630
|
| Hospital Charge Code |
113056106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of AZ Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.72
|
|
|
potassium 25 mEq (bicarbonate, effervescence tab) [CQCH]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 245532630
|
| Hospital Charge Code |
113056106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of AZ Commercial |
$0.81
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.14
|
| Rate for Payer: Banner UC Health Medicare |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.61
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.14
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of AZ Commercial |
$0.59
|
| Rate for Payer: Devoted Health Medicare |
$0.16
|
| Rate for Payer: Humana of AZ Medicare |
$0.14
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.61
|
| Rate for Payer: TriWest Medicare |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.14
|
|
|
potassium chloride 10 mEq/50 mL Sol [CQCH]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
204727734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.02
|
| Rate for Payer: Banner UC Health Medicare |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.02
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of AZ Commercial |
$0.07
|
| Rate for Payer: Devoted Health Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.02
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.07
|
| Rate for Payer: TriWest Medicare |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.02
|
|
|
potassium chloride 10 mEq/50 mL Sol [CQCH]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
204727734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of AZ Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
|
|
potassium chloride 10 mEq ER Tab [CQCH]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
108127557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of AZ Commercial |
$0.38
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.07
|
| Rate for Payer: Banner UC Health Medicare |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.07
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of AZ Commercial |
$0.27
|
| Rate for Payer: Devoted Health Medicare |
$0.08
|
| Rate for Payer: Humana of AZ Medicare |
$0.07
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.29
|
| Rate for Payer: TriWest Medicare |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.24
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.07
|
|
|
potassium chloride 10 mEq ER Tab [CQCH]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
108127557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of AZ Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.33
|
|
|
potassium chloride 20 mEq ER Tab [CQCH]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 68084036009
|
| Hospital Charge Code |
105937370
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of AZ Commercial |
$0.56
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.10
|
| Rate for Payer: Banner UC Health Medicare |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.10
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of AZ Commercial |
$0.40
|
| Rate for Payer: Devoted Health Medicare |
$0.11
|
| Rate for Payer: Humana of AZ Medicare |
$0.10
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.42
|
| Rate for Payer: TriWest Medicare |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.10
|
|
