|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,491.57
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$21,491.57 |
| Max. Negotiated Rate |
$21,491.57 |
| Rate for Payer: Seven Corners Travel Insurance |
$21,491.57
|
|
|
verapamil 80 mg Tab [CQCH]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
105945073
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
|
|
verapamil 80 mg Tab [CQCH]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
105945073
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of AZ Commercial |
$0.08
|
| Rate for Payer: Arizona Complete Health Allwell |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$0.01
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of AZ Commercial |
$0.06
|
| Rate for Payer: Devoted Health Medicare |
$0.02
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Southwest Service Administrators UFCW |
$0.06
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: Veterans Affairs TRICARE |
$0.01
|
|
|
VERRES NEEDLE
|
Facility
|
IP
|
$68.00
|
|
| Hospital Charge Code |
22354942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$54.40
|
|
|
VERRES NEEDLE
|
Facility
|
OP
|
$68.00
|
|
| Hospital Charge Code |
22354942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of AZ Commercial |
$61.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$10.88
|
| Rate for Payer: Banner UC Health Medicare |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$46.24
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$10.88
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$10.88
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cigna of AZ Commercial |
$47.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Humana of AZ Medicare |
$10.88
|
| Rate for Payer: Southwest Service Administrators UFCW |
$46.24
|
| Rate for Payer: TriWest Medicare |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$38.90
|
| Rate for Payer: United Healthcare Medicare |
$10.88
|
| Rate for Payer: Veterans Affairs TRICARE |
$10.77
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1111
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1111
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$6,980.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Hospital Charge Code |
APRDRG1111
|
| Min. Negotiated Rate |
$6,980.33 |
| Max. Negotiated Rate |
$6,980.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,980.33
|
| Rate for Payer: Mercy Care Medicaid |
$6,980.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,980.33
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$6,980.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Hospital Charge Code |
APRDRG1114
|
| Min. Negotiated Rate |
$6,980.33 |
| Max. Negotiated Rate |
$6,980.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,980.33
|
| Rate for Payer: Mercy Care Medicaid |
$6,980.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,980.33
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1111
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$6,980.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$6,980.33 |
| Max. Negotiated Rate |
$6,980.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,980.33
|
| Rate for Payer: Mercy Care Medicaid |
$6,980.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,980.33
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1112
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1112
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,838.06
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$4,238.56
|
|
|
Service Code
|
APR-DRG 1112
|
| Hospital Charge Code |
APRDRG1112
|
| Min. Negotiated Rate |
$4,238.56 |
| Max. Negotiated Rate |
$4,238.56 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$4,238.56
|
| Rate for Payer: Mercy Care Medicaid |
$4,238.56
|
| Rate for Payer: NaphCare Correctional Healthcare |
$4,238.56
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$6,980.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Hospital Charge Code |
APRDRG1112
|
| Min. Negotiated Rate |
$6,980.33 |
| Max. Negotiated Rate |
$6,980.33 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,980.33
|
| Rate for Payer: Mercy Care Medicaid |
$6,980.33
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,980.33
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$5,340.46
|
|
|
Service Code
|
APR-DRG 1113
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$5,340.46 |
| Max. Negotiated Rate |
$5,340.46 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,340.46
|
| Rate for Payer: Mercy Care Medicaid |
$5,340.46
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,340.46
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
IP
|
$3,838.06
|
|
|
Service Code
|
APR-DRG 1111
|
| Hospital Charge Code |
APRDRG1113
|
| Min. Negotiated Rate |
$3,838.06 |
| Max. Negotiated Rate |
$3,838.06 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,838.06
|
| Rate for Payer: Mercy Care Medicaid |
$3,838.06
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,838.06
|
|
|
Vesicovaginal Fistual abdominal
|
Facility
|
IP
|
$4,452.00
|
|
|
Service Code
|
CPT 51900
|
| Hospital Charge Code |
27267834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,006.80 |
| Max. Negotiated Rate |
$4,006.80 |
| Rate for Payer: Aetna of AZ Commercial |
$4,006.80
|
| Rate for Payer: Cash Price |
$3,561.60
|
|
|
Vesicovaginal Fistual abdominal
|
Facility
|
OP
|
$4,452.00
|
|
|
Service Code
|
CPT 51900
|
| Hospital Charge Code |
27267834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$705.20 |
| Max. Negotiated Rate |
$4,838.00 |
| Rate for Payer: Aetna of AZ Commercial |
$4,006.80
|
| Rate for Payer: Arizona Complete Health Allwell |
$712.32
|
| Rate for Payer: Banner UC Health Medicare |
$712.32
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3,027.36
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$712.32
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$712.32
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cigna of AZ Commercial |
$2,226.00
|
| Rate for Payer: Devoted Health Medicare |
$801.36
|
| Rate for Payer: Humana of AZ Medicare |
$712.32
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3,027.36
|
| Rate for Payer: TriWest Medicare |
$712.32
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
| Rate for Payer: United Healthcare Medicare |
$712.32
|
| Rate for Payer: Veterans Affairs TRICARE |
$705.20
|
|
|
Vesicovaginal Fistual vaginal
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
CPT 57320
|
| Hospital Charge Code |
27291798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,601.00 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Aetna of AZ Commercial |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,312.00
|
|
|
Vesicovaginal Fistual vaginal
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
CPT 57320
|
| Hospital Charge Code |
27291798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.78 |
| Max. Negotiated Rate |
$7,740.14 |
| Rate for Payer: Aetna of AZ Commercial |
$2,601.00
|
| Rate for Payer: Arizona Complete Health Allwell |
$462.40
|
| Rate for Payer: Banner UC Health Medicare |
$1,698.98
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$1,965.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$462.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$462.40
|
| Rate for Payer: Cash Price |
$2,312.00
|
| Rate for Payer: Cash Price |
$2,312.00
|
| Rate for Payer: Cash Price |
$2,312.00
|
| Rate for Payer: Cigna of AZ Commercial |
$1,445.00
|
| Rate for Payer: Devoted Health Medicare |
$520.20
|
| Rate for Payer: Humana of AZ Medicare |
$462.40
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,698.98
|
| Rate for Payer: Seven Corners Travel Insurance |
$7,740.14
|
| Rate for Payer: Southwest Service Administrators UFCW |
$1,965.20
|
| Rate for Payer: TriWest Medicare |
$462.40
|
| Rate for Payer: United Healthcare Commercial |
$4,838.00
|
| Rate for Payer: United Healthcare Medicare |
$462.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$457.78
|
|
