|
REMOVER STAPLE PROXIMATE
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
22355173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna of AZ Commercial |
$33.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.92
|
| Rate for Payer: Banner UC Health Medicare |
$5.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$25.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.92
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.92
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cigna of AZ Commercial |
$25.90
|
| Rate for Payer: Devoted Health Medicare |
$6.66
|
| Rate for Payer: Humana of AZ Medicare |
$5.92
|
| Rate for Payer: Southwest Service Administrators UFCW |
$25.16
|
| Rate for Payer: TriWest Medicare |
$5.92
|
| Rate for Payer: United Healthcare Commercial |
$21.16
|
| Rate for Payer: United Healthcare Medicare |
$5.92
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.86
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,825.63
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,825.63
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$6,833.04
|
|
|
Service Code
|
APR-DRG 4441
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$6,833.04 |
| Max. Negotiated Rate |
$6,833.04 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,833.04
|
| Rate for Payer: Mercy Care Medicaid |
$6,833.04
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,833.04
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$10,436.13
|
|
|
Service Code
|
APR-DRG 4442
|
| Hospital Charge Code |
APRDRG4443
|
| Min. Negotiated Rate |
$10,436.13 |
| Max. Negotiated Rate |
$10,436.13 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,436.13
|
| Rate for Payer: Mercy Care Medicaid |
$10,436.13
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,436.13
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$16,643.52
|
|
|
Service Code
|
APR-DRG 4443
|
| Hospital Charge Code |
APRDRG4441
|
| Min. Negotiated Rate |
$16,643.52 |
| Max. Negotiated Rate |
$16,643.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,643.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,643.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,643.52
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4442
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,825.63
|
|
|
Renal Dialysis Access Device Procedures And Vessel Repair
|
Facility
|
IP
|
$29,825.63
|
|
|
Service Code
|
APR-DRG 4444
|
| Hospital Charge Code |
APRDRG4444
|
| Min. Negotiated Rate |
$29,825.63 |
| Max. Negotiated Rate |
$29,825.63 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$29,825.63
|
| Rate for Payer: Mercy Care Medicaid |
$29,825.63
|
| Rate for Payer: NaphCare Correctional Healthcare |
$29,825.63
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$11,452.84
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$11,452.84 |
| Max. Negotiated Rate |
$11,452.84 |
| Rate for Payer: Seven Corners Travel Insurance |
$11,452.84
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$19,140.65
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$19,140.65 |
| Max. Negotiated Rate |
$19,140.65 |
| Rate for Payer: Seven Corners Travel Insurance |
$19,140.65
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$7,961.96
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$7,961.96 |
| Max. Negotiated Rate |
$7,961.96 |
| Rate for Payer: Seven Corners Travel Insurance |
$7,961.96
|
|
|
Renal Function Panel Standard
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
22141046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of AZ Commercial |
$135.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.16
|
| Rate for Payer: Banner UC Health Medicare |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$102.68
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.16
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.16
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cigna of AZ Commercial |
$98.15
|
| Rate for Payer: Devoted Health Medicare |
$27.18
|
| Rate for Payer: Humana of AZ Medicare |
$24.16
|
| Rate for Payer: Seven Corners Travel Insurance |
$12.59
|
| Rate for Payer: Southwest Service Administrators UFCW |
$102.68
|
| Rate for Payer: TriWest Medicare |
$24.16
|
| Rate for Payer: United Healthcare Commercial |
$86.37
|
| Rate for Payer: United Healthcare Medicare |
$24.16
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.92
|
|
|
Renal Function Panel Standard
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
22141046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.90 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of AZ Commercial |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
|
|
Renin Activity, Plasma LC
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
1905527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of AZ Commercial |
$247.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$44.00
|
| Rate for Payer: Banner UC Health Medicare |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$44.00
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$44.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna of AZ Commercial |
$178.75
|
| Rate for Payer: Devoted Health Medicare |
$49.50
|
| Rate for Payer: Humana of AZ Medicare |
$44.00
|
| Rate for Payer: Seven Corners Travel Insurance |
$31.89
|
| Rate for Payer: Southwest Service Administrators UFCW |
$187.00
|
| Rate for Payer: TriWest Medicare |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$157.30
|
| Rate for Payer: United Healthcare Medicare |
$44.00
|
| Rate for Payer: Veterans Affairs TRICARE |
$43.56
|
|
|
Renin Activity, Plasma LC
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
1905527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of AZ Commercial |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
|
|
REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (YOUNGER THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED FROM BIRTH UP TO 50 WEEKS POSTCONCEPTION AGE, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE
|
Facility
|
OP
|
$9,354.07
|
|
|
Service Code
|
CPT 49491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,984.28 |
| Max. Negotiated Rate |
$9,354.07 |
| Rate for Payer: Banner UC Health Medicare |
$1,984.28
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,984.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$9,354.07
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
|
