|
Procedures For Obesity
|
Facility
|
IP
|
$7,285.44
|
|
|
Service Code
|
APR-DRG 4031
|
| Hospital Charge Code |
APRDRG4034
|
| Min. Negotiated Rate |
$7,285.44 |
| Max. Negotiated Rate |
$7,285.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,285.44
|
| Rate for Payer: Mercy Care Medicaid |
$7,285.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,285.44
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8502
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,397.83
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$19,903.63
|
|
|
Service Code
|
APR-DRG 8503
|
| Hospital Charge Code |
APRDRG8501
|
| Min. Negotiated Rate |
$19,903.63 |
| Max. Negotiated Rate |
$19,903.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,903.63
|
| Rate for Payer: Mercy Care Medicaid |
$19,903.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,903.63
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8504
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$44,695.31
|
|
|
Service Code
|
APR-DRG 8504
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$44,695.31 |
| Max. Negotiated Rate |
$44,695.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$44,695.31
|
| Rate for Payer: Mercy Care Medicaid |
$44,695.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$44,695.31
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$11,244.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$11,244.14 |
| Max. Negotiated Rate |
$11,244.14 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$11,244.14
|
| Rate for Payer: Mercy Care Medicaid |
$11,244.14
|
| Rate for Payer: NaphCare Correctional Healthcare |
$11,244.14
|
|
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services
|
Facility
|
IP
|
$15,397.83
|
|
|
Service Code
|
APR-DRG 8502
|
| Hospital Charge Code |
APRDRG8503
|
| Min. Negotiated Rate |
$15,397.83 |
| Max. Negotiated Rate |
$15,397.83 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$15,397.83
|
| Rate for Payer: Mercy Care Medicaid |
$15,397.83
|
| Rate for Payer: NaphCare Correctional Healthcare |
$15,397.83
|
|
|
prochlorperazine 10 mg/2 mL Inj Sol [CQCH]
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
105952781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of AZ Commercial |
$3.51
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.62
|
| Rate for Payer: Banner UC Health Medicare |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.62
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of AZ Commercial |
$2.54
|
| Rate for Payer: Devoted Health Medicare |
$0.70
|
| Rate for Payer: Humana of AZ Medicare |
$0.62
|
| Rate for Payer: Southwest Service Administrators UFCW |
$2.65
|
| Rate for Payer: TriWest Medicare |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$2.23
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.62
|
|
|
prochlorperazine 10 mg/2 mL Inj Sol [CQCH]
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
105952781
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of AZ Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$3.12
|
|
|
prochlorperazine 25 mg Supp [CQCH]
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 713013512
|
| Hospital Charge Code |
105938267
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna of AZ Commercial |
$8.11
|
| Rate for Payer: Cash Price |
$7.21
|
|
|
prochlorperazine 25 mg Supp [CQCH]
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 713013512
|
| Hospital Charge Code |
105938267
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna of AZ Commercial |
$8.11
|
| Rate for Payer: Arizona Complete Health Allwell |
$1.44
|
| Rate for Payer: Banner UC Health Medicare |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$6.13
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1.44
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Cigna of AZ Commercial |
$5.86
|
| Rate for Payer: Devoted Health Medicare |
$1.62
|
| Rate for Payer: Humana of AZ Medicare |
$1.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$6.13
|
| Rate for Payer: TriWest Medicare |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$5.15
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$1.43
|
|
|
prochlorperazine 5 mg Tab [CQCH]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
105938198
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
|
|
prochlorperazine 5 mg Tab [CQCH]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
105938198
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of AZ Commercial |
$0.26
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.05
|
| Rate for Payer: Banner UC Health Medicare |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.05
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.05
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of AZ Commercial |
$0.19
|
| Rate for Payer: Devoted Health Medicare |
$0.05
|
| Rate for Payer: Humana of AZ Medicare |
$0.05
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.20
|
| Rate for Payer: TriWest Medicare |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.05
|
|
|
Proctosigmoidoscopy w/ or w/o Specimen Collection Charge
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
721131
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$131.20
|
|
|
Proctosigmoidoscopy w/ or w/o Specimen Collection Charge
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
721131
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$1,438.89 |
| Rate for Payer: Aetna of AZ Commercial |
$147.60
|
| Rate for Payer: Arizona Complete Health Allwell |
$26.24
|
| Rate for Payer: Banner UC Health Medicare |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$111.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$82.29
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$26.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$26.24
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cigna of AZ Commercial |
$114.80
|
| Rate for Payer: Devoted Health Medicare |
$29.52
|
| Rate for Payer: Humana of AZ Medicare |
$26.24
|
| Rate for Payer: Mercy Care Medicaid |
$82.29
|
| Rate for Payer: NaphCare Correctional Healthcare |
$82.29
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,438.89
|
| Rate for Payer: Southwest Service Administrators UFCW |
$111.52
|
| Rate for Payer: TriWest Medicare |
$26.24
|
| Rate for Payer: United Healthcare Commercial |
$93.81
|
| Rate for Payer: United Healthcare Medicare |
$26.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$25.98
|
|
