|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$8,898.35
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$8,898.35 |
| Max. Negotiated Rate |
$8,898.35 |
| Rate for Payer: Seven Corners Travel Insurance |
$8,898.35
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$4,552.09
|
|
|
Service Code
|
APR-DRG 5413
|
| Hospital Charge Code |
APRDRG5413
|
| Min. Negotiated Rate |
$4,552.09 |
| Max. Negotiated Rate |
$4,552.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,552.09
|
| Rate for Payer: Mercy Care Medicaid |
$4,552.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,552.09
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,387.76
|
|
|
Service Code
|
APR-DRG 5412
|
| Hospital Charge Code |
APRDRG5411
|
| Min. Negotiated Rate |
$3,387.76 |
| Max. Negotiated Rate |
$3,387.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,387.76
|
| Rate for Payer: Mercy Care Medicaid |
$3,387.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,387.76
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,226.44
|
|
|
Service Code
|
APR-DRG 5411
|
| Hospital Charge Code |
APRDRG5413
|
| Min. Negotiated Rate |
$3,226.44 |
| Max. Negotiated Rate |
$3,226.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,226.44
|
| Rate for Payer: Mercy Care Medicaid |
$3,226.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,226.44
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 5414
|
| Hospital Charge Code |
APRDRG5414
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,378.73
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 5414
|
| Hospital Charge Code |
APRDRG5411
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,378.73
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 5414
|
| Hospital Charge Code |
APRDRG5413
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,378.73
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$4,552.09
|
|
|
Service Code
|
APR-DRG 5413
|
| Hospital Charge Code |
APRDRG5414
|
| Min. Negotiated Rate |
$4,552.09 |
| Max. Negotiated Rate |
$4,552.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,552.09
|
| Rate for Payer: Mercy Care Medicaid |
$4,552.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,552.09
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,387.76
|
|
|
Service Code
|
APR-DRG 5412
|
| Hospital Charge Code |
APRDRG5413
|
| Min. Negotiated Rate |
$3,387.76 |
| Max. Negotiated Rate |
$3,387.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,387.76
|
| Rate for Payer: Mercy Care Medicaid |
$3,387.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,387.76
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,387.76
|
|
|
Service Code
|
APR-DRG 5412
|
| Hospital Charge Code |
APRDRG5414
|
| Min. Negotiated Rate |
$3,387.76 |
| Max. Negotiated Rate |
$3,387.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,387.76
|
| Rate for Payer: Mercy Care Medicaid |
$3,387.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,387.76
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$4,552.09
|
|
|
Service Code
|
APR-DRG 5413
|
| Hospital Charge Code |
APRDRG5412
|
| Min. Negotiated Rate |
$4,552.09 |
| Max. Negotiated Rate |
$4,552.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,552.09
|
| Rate for Payer: Mercy Care Medicaid |
$4,552.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,552.09
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,226.44
|
|
|
Service Code
|
APR-DRG 5411
|
| Hospital Charge Code |
APRDRG5414
|
| Min. Negotiated Rate |
$3,226.44 |
| Max. Negotiated Rate |
$3,226.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,226.44
|
| Rate for Payer: Mercy Care Medicaid |
$3,226.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,226.44
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$4,552.09
|
|
|
Service Code
|
APR-DRG 5413
|
| Hospital Charge Code |
APRDRG5411
|
| Min. Negotiated Rate |
$4,552.09 |
| Max. Negotiated Rate |
$4,552.09 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,552.09
|
| Rate for Payer: Mercy Care Medicaid |
$4,552.09
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,552.09
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,387.76
|
|
|
Service Code
|
APR-DRG 5412
|
| Hospital Charge Code |
APRDRG5412
|
| Min. Negotiated Rate |
$3,387.76 |
| Max. Negotiated Rate |
$3,387.76 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,387.76
|
| Rate for Payer: Mercy Care Medicaid |
$3,387.76
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,387.76
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$7,378.73
|
|
|
Service Code
|
APR-DRG 5414
|
| Hospital Charge Code |
APRDRG5412
|
| Min. Negotiated Rate |
$7,378.73 |
| Max. Negotiated Rate |
$7,378.73 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,378.73
|
| Rate for Payer: Mercy Care Medicaid |
$7,378.73
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,378.73
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,226.44
|
|
|
Service Code
|
APR-DRG 5411
|
| Hospital Charge Code |
APRDRG5411
|
| Min. Negotiated Rate |
$3,226.44 |
| Max. Negotiated Rate |
$3,226.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,226.44
|
| Rate for Payer: Mercy Care Medicaid |
$3,226.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,226.44
|
|
|
Vaginal Delivery With Sterilization And/Or D&C
|
Facility
|
IP
|
$3,226.44
|
|
|
Service Code
|
APR-DRG 5411
|
| Hospital Charge Code |
APRDRG5412
|
| Min. Negotiated Rate |
$3,226.44 |
| Max. Negotiated Rate |
$3,226.44 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,226.44
|
| Rate for Payer: Mercy Care Medicaid |
$3,226.44
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,226.44
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$13,031.69
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$13,031.69 |
| Max. Negotiated Rate |
$13,031.69 |
| Rate for Payer: Seven Corners Travel Insurance |
$13,031.69
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$15,142.73
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$15,142.73 |
| Max. Negotiated Rate |
$15,142.73 |
| Rate for Payer: Seven Corners Travel Insurance |
$15,142.73
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$12,483.04
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$12,483.04 |
| Max. Negotiated Rate |
$12,483.04 |
| Rate for Payer: Seven Corners Travel Insurance |
$12,483.04
|
|
|
Vaginectomy (complete)
|
Facility
|
IP
|
$4,935.00
|
|
|
Service Code
|
CPT 57110
|
| Hospital Charge Code |
27281895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,441.50 |
| Max. Negotiated Rate |
$4,441.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4,441.50
|
| Rate for Payer: Cash Price |
$3,948.00
|
|
|
Vaginectomy (complete)
|
Facility
|
OP
|
$4,935.00
|
|
|
Service Code
|
CPT 57110
|
| Hospital Charge Code |
27281895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$781.70 |
| Max. Negotiated Rate |
$4,441.50 |
| Rate for Payer: Aetna of AZ Commercial |
$4,441.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$789.60
|
| Rate for Payer: Banner UC Health Medicare |
$789.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3,355.80
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$789.60
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$789.60
|
| Rate for Payer: Cash Price |
$3,948.00
|
| Rate for Payer: Cash Price |
$3,948.00
|
| Rate for Payer: Cigna of AZ Commercial |
$2,467.50
|
| Rate for Payer: Devoted Health Medicare |
$888.30
|
| Rate for Payer: Humana of AZ Medicare |
$789.60
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3,355.80
|
| Rate for Payer: TriWest Medicare |
$789.60
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$789.60
|
| Rate for Payer: Veterans Affairs TRICARE |
$781.70
|
|
|
Vaginectomy (partial vaginal apex revision)
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 57106
|
| Hospital Charge Code |
27291799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$434.02 |
| Max. Negotiated Rate |
$5,008.71 |
| Rate for Payer: Aetna of AZ Commercial |
$2,466.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$438.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,051.19
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,863.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$438.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$438.40
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,370.00
|
| Rate for Payer: Devoted Health Medicare |
$493.20
|
| Rate for Payer: Humana of AZ Medicare |
$438.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,051.19
|
| Rate for Payer: Seven Corners Travel Insurance |
$5,008.71
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,863.20
|
| Rate for Payer: TriWest Medicare |
$438.40
|
| Rate for Payer: United Healthcare Commercial |
$4,169.00
|
| Rate for Payer: United Healthcare Medicare |
$438.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$434.02
|
|
|
Vaginectomy (partial vaginal apex revision)
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
CPT 57106
|
| Hospital Charge Code |
27291799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,466.00 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,466.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
|
|
Valproic Acid Level
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna of AZ Commercial |
$215.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$38.24
|
| Rate for Payer: Banner UC Health Medicare |
$38.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$162.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$38.24
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$38.24
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cigna of AZ Commercial |
$155.35
|
| Rate for Payer: Devoted Health Medicare |
$43.02
|
| Rate for Payer: Humana of AZ Medicare |
$38.24
|
| Rate for Payer: Seven Corners Travel Insurance |
$19.63
|
| Rate for Payer: Southwest Service Administrators UFCW |
$162.52
|
| Rate for Payer: TriWest Medicare |
$38.24
|
| Rate for Payer: United Healthcare Commercial |
$136.71
|
| Rate for Payer: United Healthcare Medicare |
$38.24
|
| Rate for Payer: Veterans Affairs TRICARE |
$37.86
|
|
