|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$10,628.31
|
|
|
Service Code
|
APR-DRG 5112
|
| Hospital Charge Code |
APRDRG5112
|
| Min. Negotiated Rate |
$10,628.31 |
| Max. Negotiated Rate |
$10,628.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,628.31
|
| Rate for Payer: Mercy Care Medicaid |
$10,628.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,628.31
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$10,628.31
|
|
|
Service Code
|
APR-DRG 5112
|
| Hospital Charge Code |
APRDRG5114
|
| Min. Negotiated Rate |
$10,628.31 |
| Max. Negotiated Rate |
$10,628.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,628.31
|
| Rate for Payer: Mercy Care Medicaid |
$10,628.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,628.31
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$8,883.93
|
|
|
Service Code
|
APR-DRG 5111
|
| Hospital Charge Code |
APRDRG5112
|
| Min. Negotiated Rate |
$8,883.93 |
| Max. Negotiated Rate |
$8,883.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,883.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,883.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,883.93
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$10,628.31
|
|
|
Service Code
|
APR-DRG 5112
|
| Hospital Charge Code |
APRDRG5113
|
| Min. Negotiated Rate |
$10,628.31 |
| Max. Negotiated Rate |
$10,628.31 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,628.31
|
| Rate for Payer: Mercy Care Medicaid |
$10,628.31
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,628.31
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$16,776.79
|
|
|
Service Code
|
APR-DRG 5113
|
| Hospital Charge Code |
APRDRG5114
|
| Min. Negotiated Rate |
$16,776.79 |
| Max. Negotiated Rate |
$16,776.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,776.79
|
| Rate for Payer: Mercy Care Medicaid |
$16,776.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,776.79
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$30,793.56
|
|
|
Service Code
|
APR-DRG 5114
|
| Hospital Charge Code |
APRDRG5112
|
| Min. Negotiated Rate |
$30,793.56 |
| Max. Negotiated Rate |
$30,793.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$30,793.56
|
| Rate for Payer: Mercy Care Medicaid |
$30,793.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$30,793.56
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$8,883.93
|
|
|
Service Code
|
APR-DRG 5111
|
| Hospital Charge Code |
APRDRG5113
|
| Min. Negotiated Rate |
$8,883.93 |
| Max. Negotiated Rate |
$8,883.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,883.93
|
| Rate for Payer: Mercy Care Medicaid |
$8,883.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,883.93
|
|
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
Facility
|
IP
|
$30,793.56
|
|
|
Service Code
|
APR-DRG 5114
|
| Hospital Charge Code |
APRDRG5111
|
| Min. Negotiated Rate |
$30,793.56 |
| Max. Negotiated Rate |
$30,793.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$30,793.56
|
| Rate for Payer: Mercy Care Medicaid |
$30,793.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$30,793.56
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$26,631.48
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$26,631.48 |
| Max. Negotiated Rate |
$26,631.48 |
| Rate for Payer: Seven Corners Travel Insurance |
$26,631.48
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$46,197.36
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$46,197.36 |
| Max. Negotiated Rate |
$46,197.36 |
| Rate for Payer: Seven Corners Travel Insurance |
$46,197.36
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$18,979.11
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$18,979.11 |
| Max. Negotiated Rate |
$18,979.11 |
| Rate for Payer: Seven Corners Travel Insurance |
$18,979.11
|
|
|
Uterine Suspension
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT 58400
|
| Hospital Charge Code |
22754022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,259.00 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,259.00
|
| Rate for Payer: Cash Price |
$2,008.00
|
|
|
Uterine Suspension
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT 58400
|
| Hospital Charge Code |
22754022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$397.58 |
| Max. Negotiated Rate |
$4,169.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,259.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$401.60
|
| Rate for Payer: Banner UC Health Medicare |
$401.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,706.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$401.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$401.60
|
| Rate for Payer: Cash Price |
$2,008.00
|
| Rate for Payer: Cash Price |
$2,008.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,255.00
|
| Rate for Payer: Devoted Health Medicare |
$451.80
|
| Rate for Payer: Humana of AZ Medicare |
$401.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,706.80
|
| Rate for Payer: TriWest Medicare |
$401.60
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$401.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$397.58
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$22,450.49
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$22,450.49 |
| Max. Negotiated Rate |
$22,450.49 |
| Rate for Payer: Seven Corners Travel Insurance |
$22,450.49
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,248.87
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$11,248.87 |
| Max. Negotiated Rate |
$11,248.87 |
| Rate for Payer: Seven Corners Travel Insurance |
$11,248.87
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$2,362.32
|
|
|
Service Code
|
APR-DRG 5602
|
| Hospital Charge Code |
APRDRG5603
|
| Min. Negotiated Rate |
$2,362.32 |
| Max. Negotiated Rate |
$2,362.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,362.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,362.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,362.32
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$4,964.51
|
|
|
Service Code
|
APR-DRG 5604
|
| Hospital Charge Code |
APRDRG5603
|
| Min. Negotiated Rate |
$4,964.51 |
| Max. Negotiated Rate |
$4,964.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,964.51
|
| Rate for Payer: Mercy Care Medicaid |
$4,964.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,964.51
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$4,964.51
|
|
|
Service Code
|
APR-DRG 5604
|
| Hospital Charge Code |
APRDRG5604
|
| Min. Negotiated Rate |
$4,964.51 |
| Max. Negotiated Rate |
$4,964.51 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,964.51
|
| Rate for Payer: Mercy Care Medicaid |
$4,964.51
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,964.51
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$3,306.40
|
|
|
Service Code
|
APR-DRG 5603
|
| Hospital Charge Code |
APRDRG5603
|
| Min. Negotiated Rate |
$3,306.40 |
| Max. Negotiated Rate |
$3,306.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,306.40
|
| Rate for Payer: Mercy Care Medicaid |
$3,306.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,306.40
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$2,095.78
|
|
|
Service Code
|
APR-DRG 5601
|
| Hospital Charge Code |
APRDRG5604
|
| Min. Negotiated Rate |
$2,095.78 |
| Max. Negotiated Rate |
$2,095.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,095.78
|
| Rate for Payer: Mercy Care Medicaid |
$2,095.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,095.78
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$3,306.40
|
|
|
Service Code
|
APR-DRG 5603
|
| Hospital Charge Code |
APRDRG5601
|
| Min. Negotiated Rate |
$3,306.40 |
| Max. Negotiated Rate |
$3,306.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,306.40
|
| Rate for Payer: Mercy Care Medicaid |
$3,306.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,306.40
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$2,362.32
|
|
|
Service Code
|
APR-DRG 5602
|
| Hospital Charge Code |
APRDRG5604
|
| Min. Negotiated Rate |
$2,362.32 |
| Max. Negotiated Rate |
$2,362.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,362.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,362.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,362.32
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$3,306.40
|
|
|
Service Code
|
APR-DRG 5603
|
| Hospital Charge Code |
APRDRG5602
|
| Min. Negotiated Rate |
$3,306.40 |
| Max. Negotiated Rate |
$3,306.40 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,306.40
|
| Rate for Payer: Mercy Care Medicaid |
$3,306.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,306.40
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$2,095.78
|
|
|
Service Code
|
APR-DRG 5601
|
| Hospital Charge Code |
APRDRG5602
|
| Min. Negotiated Rate |
$2,095.78 |
| Max. Negotiated Rate |
$2,095.78 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,095.78
|
| Rate for Payer: Mercy Care Medicaid |
$2,095.78
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,095.78
|
|
|
Vaginal Delivery
|
Facility
|
IP
|
$2,362.32
|
|
|
Service Code
|
APR-DRG 5602
|
| Hospital Charge Code |
APRDRG5602
|
| Min. Negotiated Rate |
$2,362.32 |
| Max. Negotiated Rate |
$2,362.32 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,362.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,362.32
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,362.32
|
|
