|
Allergic Reactions
|
Facility
|
IP
|
$3,439.67
|
|
|
Service Code
|
APR-DRG 8112
|
| Hospital Charge Code |
APRDRG8114
|
| Min. Negotiated Rate |
$3,439.67 |
| Max. Negotiated Rate |
$3,439.67 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,439.67
|
| Rate for Payer: Mercy Care Medicaid |
$3,439.67
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,439.67
|
|
|
Allergic Reactions
|
Facility
|
IP
|
$6,558.79
|
|
|
Service Code
|
APR-DRG 8113
|
| Hospital Charge Code |
APRDRG8112
|
| Min. Negotiated Rate |
$6,558.79 |
| Max. Negotiated Rate |
$6,558.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$6,558.79
|
| Rate for Payer: Mercy Care Medicaid |
$6,558.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$6,558.79
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$21,733.24
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$21,733.24 |
| Max. Negotiated Rate |
$21,733.24 |
| Rate for Payer: Seven Corners Travel Insurance |
$21,733.24
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$8,798.22
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$8,798.22 |
| Max. Negotiated Rate |
$8,798.22 |
| Rate for Payer: Seven Corners Travel Insurance |
$8,798.22
|
|
|
ALLERGN PNUT
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
22481457
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of AZ Commercial |
$58.50
|
| Rate for Payer: Cash Price |
$52.00
|
|
|
ALLERGN PNUT
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
22481457
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of AZ Commercial |
$58.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$10.40
|
| Rate for Payer: Banner UC Health Medicare |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$10.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$10.40
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna of AZ Commercial |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$11.70
|
| Rate for Payer: Humana of AZ Medicare |
$10.40
|
| Rate for Payer: Seven Corners Travel Insurance |
$7.57
|
| Rate for Payer: Southwest Service Administrators UFCW |
$44.20
|
| Rate for Payer: TriWest Medicare |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$37.18
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$10.30
|
|
|
Allergy Injection Multi POC
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
2435615
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Arizona Complete Health Allwell |
$13.28
|
| Rate for Payer: Banner UC Health Medicare |
$13.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$13.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$13.28
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cigna of AZ Commercial |
$58.10
|
| Rate for Payer: Devoted Health Medicare |
$14.94
|
| Rate for Payer: Humana of AZ Medicare |
$13.28
|
| Rate for Payer: Seven Corners Travel Insurance |
$72.46
|
| Rate for Payer: Southwest Service Administrators UFCW |
$56.44
|
| Rate for Payer: TriWest Medicare |
$13.28
|
| Rate for Payer: United Healthcare Commercial |
$47.48
|
| Rate for Payer: United Healthcare Medicare |
$13.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$13.15
|
|
|
Allergy Injection Multi POC
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
2435615
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of AZ Commercial |
$74.70
|
| Rate for Payer: Cash Price |
$66.40
|
|
|
Allergy Injection Single POC
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
2435614
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$72.46 |
| Rate for Payer: Aetna of AZ Commercial |
$59.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$10.56
|
| Rate for Payer: Banner UC Health Medicare |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$44.88
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$10.56
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of AZ Commercial |
$46.20
|
| Rate for Payer: Devoted Health Medicare |
$11.88
|
| Rate for Payer: Humana of AZ Medicare |
$10.56
|
| Rate for Payer: Seven Corners Travel Insurance |
$72.46
|
| Rate for Payer: Southwest Service Administrators UFCW |
$44.88
|
| Rate for Payer: TriWest Medicare |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$37.75
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: Veterans Affairs TRICARE |
$10.45
|
|
|
Allergy Injection Single POC
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
2435614
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of AZ Commercial |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
|
|
Alliance II Syringe/ Gauge Assemble
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
22926471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of AZ Commercial |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
|
|
Alliance II Syringe/ Gauge Assemble
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
22926471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of AZ Commercial |
$132.30
|
| Rate for Payer: Arizona Complete Health Allwell |
$23.52
|
| Rate for Payer: Banner UC Health Medicare |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$23.52
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$23.52
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna of AZ Commercial |
$102.90
|
| Rate for Payer: Devoted Health Medicare |
$26.46
|
| Rate for Payer: Humana of AZ Medicare |
$23.52
|
| Rate for Payer: Southwest Service Administrators UFCW |
$99.96
|
| Rate for Payer: TriWest Medicare |
$23.52
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
| Rate for Payer: United Healthcare Medicare |
$23.52
|
| Rate for Payer: Veterans Affairs TRICARE |
$23.28
|
|
|
ALLIANCE II SYRINGE GAUGE ASSEMBLE
|
Facility
|
IP
|
$151.70
|
|
| Hospital Charge Code |
27497399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$136.53 |
| Rate for Payer: Aetna of AZ Commercial |
$136.53
|
| Rate for Payer: Cash Price |
$121.36
|
|
|
ALLIANCE II SYRINGE GAUGE ASSEMBLE
|
Facility
|
OP
|
$151.70
|
|
| Hospital Charge Code |
27497399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$136.53 |
| Rate for Payer: Aetna of AZ Commercial |
$136.53
|
| Rate for Payer: Arizona Complete Health Allwell |
$24.27
|
| Rate for Payer: Banner UC Health Medicare |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$103.16
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$24.27
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$24.27
|
| Rate for Payer: Cash Price |
$121.36
|
| Rate for Payer: Cigna of AZ Commercial |
$106.19
|
| Rate for Payer: Devoted Health Medicare |
$27.31
|
| Rate for Payer: Humana of AZ Medicare |
$24.27
|
| Rate for Payer: Southwest Service Administrators UFCW |
$103.16
|
| Rate for Payer: TriWest Medicare |
$24.27
|
| Rate for Payer: United Healthcare Commercial |
$86.77
|
| Rate for Payer: United Healthcare Medicare |
$24.27
|
| Rate for Payer: Veterans Affairs TRICARE |
$24.03
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$40,658.05
|
|
|
Service Code
|
APR-DRG 0071
|
| Hospital Charge Code |
APRDRG0071
|
| Min. Negotiated Rate |
$40,658.05 |
| Max. Negotiated Rate |
$40,658.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$40,658.05
|
| Rate for Payer: Mercy Care Medicaid |
$40,658.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$40,658.05
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$70,931.88
|
|
|
Service Code
|
APR-DRG 0073
|
| Hospital Charge Code |
APRDRG0072
|
| Min. Negotiated Rate |
$70,931.88 |
| Max. Negotiated Rate |
$70,931.88 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$70,931.88
|
| Rate for Payer: Mercy Care Medicaid |
$70,931.88
|
| Rate for Payer: NaphCare Correctional Healthcare |
$70,931.88
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$40,658.05
|
|
|
Service Code
|
APR-DRG 0071
|
| Hospital Charge Code |
APRDRG0073
|
| Min. Negotiated Rate |
$40,658.05 |
| Max. Negotiated Rate |
$40,658.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$40,658.05
|
| Rate for Payer: Mercy Care Medicaid |
$40,658.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$40,658.05
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$40,658.05
|
|
|
Service Code
|
APR-DRG 0071
|
| Hospital Charge Code |
APRDRG0072
|
| Min. Negotiated Rate |
$40,658.05 |
| Max. Negotiated Rate |
$40,658.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$40,658.05
|
| Rate for Payer: Mercy Care Medicaid |
$40,658.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$40,658.05
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$137,807.57
|
|
|
Service Code
|
APR-DRG 0074
|
| Hospital Charge Code |
APRDRG0072
|
| Min. Negotiated Rate |
$137,807.57 |
| Max. Negotiated Rate |
$137,807.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$137,807.57
|
| Rate for Payer: Mercy Care Medicaid |
$137,807.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$137,807.57
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$58,909.18
|
|
|
Service Code
|
APR-DRG 0072
|
| Hospital Charge Code |
APRDRG0071
|
| Min. Negotiated Rate |
$58,909.18 |
| Max. Negotiated Rate |
$58,909.18 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$58,909.18
|
| Rate for Payer: Mercy Care Medicaid |
$58,909.18
|
| Rate for Payer: NaphCare Correctional Healthcare |
$58,909.18
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$137,807.57
|
|
|
Service Code
|
APR-DRG 0074
|
| Hospital Charge Code |
APRDRG0073
|
| Min. Negotiated Rate |
$137,807.57 |
| Max. Negotiated Rate |
$137,807.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$137,807.57
|
| Rate for Payer: Mercy Care Medicaid |
$137,807.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$137,807.57
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$70,931.88
|
|
|
Service Code
|
APR-DRG 0073
|
| Hospital Charge Code |
APRDRG0073
|
| Min. Negotiated Rate |
$70,931.88 |
| Max. Negotiated Rate |
$70,931.88 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$70,931.88
|
| Rate for Payer: Mercy Care Medicaid |
$70,931.88
|
| Rate for Payer: NaphCare Correctional Healthcare |
$70,931.88
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$137,807.57
|
|
|
Service Code
|
APR-DRG 0074
|
| Hospital Charge Code |
APRDRG0074
|
| Min. Negotiated Rate |
$137,807.57 |
| Max. Negotiated Rate |
$137,807.57 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$137,807.57
|
| Rate for Payer: Mercy Care Medicaid |
$137,807.57
|
| Rate for Payer: NaphCare Correctional Healthcare |
$137,807.57
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$40,658.05
|
|
|
Service Code
|
APR-DRG 0071
|
| Hospital Charge Code |
APRDRG0074
|
| Min. Negotiated Rate |
$40,658.05 |
| Max. Negotiated Rate |
$40,658.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$40,658.05
|
| Rate for Payer: Mercy Care Medicaid |
$40,658.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$40,658.05
|
|
|
Allogeneic Bone Marrow Transplant
|
Facility
|
IP
|
$70,931.88
|
|
|
Service Code
|
APR-DRG 0073
|
| Hospital Charge Code |
APRDRG0071
|
| Min. Negotiated Rate |
$70,931.88 |
| Max. Negotiated Rate |
$70,931.88 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$70,931.88
|
| Rate for Payer: Mercy Care Medicaid |
$70,931.88
|
| Rate for Payer: NaphCare Correctional Healthcare |
$70,931.88
|
|
