|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$19,074.57
|
|
|
Service Code
|
APR-DRG 1301
|
| Hospital Charge Code |
APRDRG1302
|
| Min. Negotiated Rate |
$19,074.57 |
| Max. Negotiated Rate |
$19,074.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,074.57
|
| Rate for Payer: Mercy Care Medicaid |
$19,074.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,074.57
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$22,654.52
|
|
|
Service Code
|
APR-DRG 1302
|
| Hospital Charge Code |
APRDRG1304
|
| Min. Negotiated Rate |
$22,654.52 |
| Max. Negotiated Rate |
$22,654.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,654.52
|
| Rate for Payer: Mercy Care Medicaid |
$22,654.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,654.52
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$19,074.57
|
|
|
Service Code
|
APR-DRG 1301
|
| Hospital Charge Code |
APRDRG1303
|
| Min. Negotiated Rate |
$19,074.57 |
| Max. Negotiated Rate |
$19,074.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,074.57
|
| Rate for Payer: Mercy Care Medicaid |
$19,074.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,074.57
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$35,760.18
|
|
|
Service Code
|
APR-DRG 1304
|
| Hospital Charge Code |
APRDRG1302
|
| Min. Negotiated Rate |
$35,760.18 |
| Max. Negotiated Rate |
$35,760.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,760.18
|
| Rate for Payer: Mercy Care Medicaid |
$35,760.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,760.18
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$35,760.18
|
|
|
Service Code
|
APR-DRG 1304
|
| Hospital Charge Code |
APRDRG1303
|
| Min. Negotiated Rate |
$35,760.18 |
| Max. Negotiated Rate |
$35,760.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,760.18
|
| Rate for Payer: Mercy Care Medicaid |
$35,760.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,760.18
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$26,639.87
|
|
|
Service Code
|
APR-DRG 1303
|
| Hospital Charge Code |
APRDRG1301
|
| Min. Negotiated Rate |
$26,639.87 |
| Max. Negotiated Rate |
$26,639.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,639.87
|
| Rate for Payer: Mercy Care Medicaid |
$26,639.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,639.87
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$22,654.52
|
|
|
Service Code
|
APR-DRG 1302
|
| Hospital Charge Code |
APRDRG1302
|
| Min. Negotiated Rate |
$22,654.52 |
| Max. Negotiated Rate |
$22,654.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,654.52
|
| Rate for Payer: Mercy Care Medicaid |
$22,654.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,654.52
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$22,654.52
|
|
|
Service Code
|
APR-DRG 1302
|
| Hospital Charge Code |
APRDRG1303
|
| Min. Negotiated Rate |
$22,654.52 |
| Max. Negotiated Rate |
$22,654.52 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$22,654.52
|
| Rate for Payer: Mercy Care Medicaid |
$22,654.52
|
| Rate for Payer: NaphCare Correctional Healthcare |
$22,654.52
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$26,639.87
|
|
|
Service Code
|
APR-DRG 1303
|
| Hospital Charge Code |
APRDRG1302
|
| Min. Negotiated Rate |
$26,639.87 |
| Max. Negotiated Rate |
$26,639.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,639.87
|
| Rate for Payer: Mercy Care Medicaid |
$26,639.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,639.87
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$19,074.57
|
|
|
Service Code
|
APR-DRG 1301
|
| Hospital Charge Code |
APRDRG1304
|
| Min. Negotiated Rate |
$19,074.57 |
| Max. Negotiated Rate |
$19,074.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,074.57
|
| Rate for Payer: Mercy Care Medicaid |
$19,074.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,074.57
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$35,760.18
|
|
|
Service Code
|
APR-DRG 1304
|
| Hospital Charge Code |
APRDRG1301
|
| Min. Negotiated Rate |
$35,760.18 |
| Max. Negotiated Rate |
$35,760.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$35,760.18
|
| Rate for Payer: Mercy Care Medicaid |
$35,760.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$35,760.18
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$19,074.57
|
|
|
Service Code
|
APR-DRG 1301
|
| Hospital Charge Code |
APRDRG1301
|
| Min. Negotiated Rate |
$19,074.57 |
| Max. Negotiated Rate |
$19,074.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$19,074.57
|
| Rate for Payer: Mercy Care Medicaid |
$19,074.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$19,074.57
|
|
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
Facility
|
IP
|
$26,639.87
|
|
|
Service Code
|
APR-DRG 1303
|
| Hospital Charge Code |
APRDRG1304
|
| Min. Negotiated Rate |
$26,639.87 |
| Max. Negotiated Rate |
$26,639.87 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$26,639.87
|
| Rate for Payer: Mercy Care Medicaid |
$26,639.87
|
| Rate for Payer: NaphCare Correctional Healthcare |
$26,639.87
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$35,524.58
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$35,524.58 |
| Max. Negotiated Rate |
$35,524.58 |
| Rate for Payer: Seven Corners Travel Insurance |
$35,524.58
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$83,162.95
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$83,162.95 |
| Max. Negotiated Rate |
$83,162.95 |
| Rate for Payer: Seven Corners Travel Insurance |
$83,162.95
|
|
|
Respiratory Therapy
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
853605
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$693.90 |
| Max. Negotiated Rate |
$693.90 |
| Rate for Payer: Aetna of AZ Commercial |
$693.90
|
| Rate for Payer: Cash Price |
$616.80
|
|
|
Respiratory Therapy
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
884915
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$767.70 |
| Max. Negotiated Rate |
$767.70 |
| Rate for Payer: Aetna of AZ Commercial |
$767.70
|
| Rate for Payer: Cash Price |
$682.40
|
|
|
Respiratory Therapy
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
884915
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$767.70 |
| Rate for Payer: Aetna of AZ Commercial |
$767.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$136.48
|
| Rate for Payer: Banner UC Health Medicare |
$136.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$580.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$136.48
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$136.48
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cash Price |
$682.40
|
| Rate for Payer: Cigna of AZ Commercial |
$597.10
|
| Rate for Payer: Devoted Health Medicare |
$153.54
|
| Rate for Payer: Humana of AZ Medicare |
$136.48
|
| Rate for Payer: Seven Corners Travel Insurance |
$577.38
|
| Rate for Payer: Southwest Service Administrators UFCW |
$580.04
|
| Rate for Payer: TriWest Medicare |
$136.48
|
| Rate for Payer: United Healthcare Commercial |
$487.92
|
| Rate for Payer: United Healthcare Medicare |
$136.48
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$162.07
|
| Rate for Payer: Veterans Affairs TRICARE |
$135.12
|
|
|
Respiratory Therapy
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
853605
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$122.13 |
| Max. Negotiated Rate |
$693.90 |
| Rate for Payer: Aetna of AZ Commercial |
$693.90
|
| Rate for Payer: Arizona Complete Health Allwell |
$123.36
|
| Rate for Payer: Banner UC Health Medicare |
$123.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$524.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$123.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$123.36
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna of AZ Commercial |
$539.70
|
| Rate for Payer: Devoted Health Medicare |
$138.78
|
| Rate for Payer: Humana of AZ Medicare |
$123.36
|
| Rate for Payer: Seven Corners Travel Insurance |
$334.09
|
| Rate for Payer: Southwest Service Administrators UFCW |
$524.28
|
| Rate for Payer: TriWest Medicare |
$123.36
|
| Rate for Payer: United Healthcare Commercial |
$441.01
|
| Rate for Payer: United Healthcare Medicare |
$123.36
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$146.49
|
| Rate for Payer: Veterans Affairs TRICARE |
$122.13
|
|
|
RESTRAINT LIMB
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
22354291
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of AZ Commercial |
$17.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$3.04
|
| Rate for Payer: Banner UC Health Medicare |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$3.04
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cigna of AZ Commercial |
$13.30
|
| Rate for Payer: Devoted Health Medicare |
$3.42
|
| Rate for Payer: Humana of AZ Medicare |
$3.04
|
| Rate for Payer: Southwest Service Administrators UFCW |
$12.92
|
| Rate for Payer: TriWest Medicare |
$3.04
|
| Rate for Payer: United Healthcare Commercial |
$10.87
|
| Rate for Payer: United Healthcare Medicare |
$3.04
|
| Rate for Payer: Veterans Affairs TRICARE |
$3.01
|
|
|
RESTRAINT LIMB
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
22354291
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of AZ Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$15.20
|
|
|
RESUSCITATION
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1886871
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$141.21 |
| Max. Negotiated Rate |
$1,616.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,616.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$287.36
|
| Rate for Payer: Banner UC Health Medicare |
$287.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,221.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$141.21
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$287.36
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$287.36
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cigna of AZ Commercial |
$1,257.20
|
| Rate for Payer: Devoted Health Medicare |
$323.28
|
| Rate for Payer: Humana of AZ Medicare |
$287.36
|
| Rate for Payer: Mercy Care Medicaid |
$141.21
|
| Rate for Payer: NaphCare Correctional Healthcare |
$141.21
|
| Rate for Payer: Seven Corners Travel Insurance |
$334.09
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,221.28
|
| Rate for Payer: TriWest Medicare |
$287.36
|
| Rate for Payer: United Healthcare Commercial |
$1,027.31
|
| Rate for Payer: United Healthcare Medicare |
$287.36
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$341.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$284.49
|
|
|
RESUSCITATION
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
1886871
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,616.40 |
| Max. Negotiated Rate |
$1,616.40 |
| Rate for Payer: Aetna of AZ Commercial |
$1,616.40
|
| Rate for Payer: Cash Price |
$1,436.80
|
|
|
Reticulocyte Count LC
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
1909555
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$12.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$8.80
|
| Rate for Payer: Banner UC Health Medicare |
$12.80
|
| Rate for Payer: Banner UC Health Medicare |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$12.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$8.80
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$12.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of AZ Commercial |
$52.00
|
| Rate for Payer: Cigna of AZ Commercial |
$35.75
|
| Rate for Payer: Devoted Health Medicare |
$14.40
|
| Rate for Payer: Devoted Health Medicare |
$9.90
|
| Rate for Payer: Humana of AZ Medicare |
$8.80
|
| Rate for Payer: Humana of AZ Medicare |
$12.80
|
| Rate for Payer: Seven Corners Travel Insurance |
$5.79
|
| Rate for Payer: Seven Corners Travel Insurance |
$5.79
|
| Rate for Payer: Southwest Service Administrators UFCW |
$54.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$37.40
|
| Rate for Payer: TriWest Medicare |
$8.80
|
| Rate for Payer: TriWest Medicare |
$12.80
|
| Rate for Payer: United Healthcare Commercial |
$31.46
|
| Rate for Payer: United Healthcare Commercial |
$45.76
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$12.80
|
| Rate for Payer: Veterans Affairs TRICARE |
$12.67
|
| Rate for Payer: Veterans Affairs TRICARE |
$8.71
|
|
|
Reticulocyte Count LC
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
1909555
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of AZ Commercial |
$72.00
|
| Rate for Payer: Aetna of AZ Commercial |
$49.50
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$44.00
|
|
