|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$17,058.05
|
|
|
Service Code
|
APR-DRG 5474
|
| Hospital Charge Code |
APRDRG5473
|
| Min. Negotiated Rate |
$17,058.05 |
| Max. Negotiated Rate |
$17,058.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,058.05
|
| Rate for Payer: Mercy Care Medicaid |
$17,058.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,058.05
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$3,966.42
|
|
|
Service Code
|
APR-DRG 5471
|
| Hospital Charge Code |
APRDRG5474
|
| Min. Negotiated Rate |
$3,966.42 |
| Max. Negotiated Rate |
$3,966.42 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,966.42
|
| Rate for Payer: Mercy Care Medicaid |
$3,966.42
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,966.42
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$17,058.05
|
|
|
Service Code
|
APR-DRG 5474
|
| Hospital Charge Code |
APRDRG5471
|
| Min. Negotiated Rate |
$17,058.05 |
| Max. Negotiated Rate |
$17,058.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,058.05
|
| Rate for Payer: Mercy Care Medicaid |
$17,058.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,058.05
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$17,058.05
|
|
|
Service Code
|
APR-DRG 5474
|
| Hospital Charge Code |
APRDRG5474
|
| Min. Negotiated Rate |
$17,058.05 |
| Max. Negotiated Rate |
$17,058.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,058.05
|
| Rate for Payer: Mercy Care Medicaid |
$17,058.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,058.05
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$9,132.93
|
|
|
Service Code
|
APR-DRG 5473
|
| Hospital Charge Code |
APRDRG5474
|
| Min. Negotiated Rate |
$9,132.93 |
| Max. Negotiated Rate |
$9,132.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,132.93
|
| Rate for Payer: Mercy Care Medicaid |
$9,132.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,132.93
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$5,686.95
|
|
|
Service Code
|
APR-DRG 5472
|
| Hospital Charge Code |
APRDRG5473
|
| Min. Negotiated Rate |
$5,686.95 |
| Max. Negotiated Rate |
$5,686.95 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,686.95
|
| Rate for Payer: Mercy Care Medicaid |
$5,686.95
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,686.95
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$9,132.93
|
|
|
Service Code
|
APR-DRG 5473
|
| Hospital Charge Code |
APRDRG5473
|
| Min. Negotiated Rate |
$9,132.93 |
| Max. Negotiated Rate |
$9,132.93 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$9,132.93
|
| Rate for Payer: Mercy Care Medicaid |
$9,132.93
|
| Rate for Payer: NaphCare Correctional Healthcare |
$9,132.93
|
|
|
Antepartum With O.R. Procedure
|
Facility
|
IP
|
$17,058.05
|
|
|
Service Code
|
APR-DRG 5474
|
| Hospital Charge Code |
APRDRG5472
|
| Min. Negotiated Rate |
$17,058.05 |
| Max. Negotiated Rate |
$17,058.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$17,058.05
|
| Rate for Payer: Mercy Care Medicaid |
$17,058.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$17,058.05
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$8,013.50
|
|
|
Service Code
|
APR-DRG 5664
|
| Hospital Charge Code |
APRDRG5663
|
| Min. Negotiated Rate |
$8,013.50 |
| Max. Negotiated Rate |
$8,013.50 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,013.50
|
| Rate for Payer: Mercy Care Medicaid |
$8,013.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,013.50
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$2,480.15
|
|
|
Service Code
|
APR-DRG 5662
|
| Hospital Charge Code |
APRDRG5662
|
| Min. Negotiated Rate |
$2,480.15 |
| Max. Negotiated Rate |
$2,480.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,480.15
|
| Rate for Payer: Mercy Care Medicaid |
$2,480.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,480.15
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$2,480.15
|
|
|
Service Code
|
APR-DRG 5662
|
| Hospital Charge Code |
APRDRG5664
|
| Min. Negotiated Rate |
$2,480.15 |
| Max. Negotiated Rate |
$2,480.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,480.15
|
| Rate for Payer: Mercy Care Medicaid |
$2,480.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,480.15
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$3,676.74
|
|
|
Service Code
|
APR-DRG 5663
|
| Hospital Charge Code |
APRDRG5663
|
| Min. Negotiated Rate |
$3,676.74 |
| Max. Negotiated Rate |
$3,676.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,676.74
|
| Rate for Payer: Mercy Care Medicaid |
$3,676.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,676.74
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$3,676.74
|
|
|
Service Code
|
APR-DRG 5663
|
| Hospital Charge Code |
APRDRG5661
|
| Min. Negotiated Rate |
$3,676.74 |
| Max. Negotiated Rate |
$3,676.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,676.74
|
| Rate for Payer: Mercy Care Medicaid |
$3,676.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,676.74
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$3,676.74
|
|
|
Service Code
|
APR-DRG 5663
|
| Hospital Charge Code |
APRDRG5664
|
| Min. Negotiated Rate |
$3,676.74 |
| Max. Negotiated Rate |
$3,676.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,676.74
|
| Rate for Payer: Mercy Care Medicaid |
$3,676.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,676.74
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$1,894.48
|
|
|
Service Code
|
APR-DRG 5661
|
| Hospital Charge Code |
APRDRG5664
|
| Min. Negotiated Rate |
$1,894.48 |
| Max. Negotiated Rate |
$1,894.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,894.48
|
| Rate for Payer: Mercy Care Medicaid |
$1,894.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,894.48
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$8,013.50
|
|
|
Service Code
|
APR-DRG 5664
|
| Hospital Charge Code |
APRDRG5662
|
| Min. Negotiated Rate |
$8,013.50 |
| Max. Negotiated Rate |
$8,013.50 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,013.50
|
| Rate for Payer: Mercy Care Medicaid |
$8,013.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,013.50
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$8,013.50
|
|
|
Service Code
|
APR-DRG 5664
|
| Hospital Charge Code |
APRDRG5664
|
| Min. Negotiated Rate |
$8,013.50 |
| Max. Negotiated Rate |
$8,013.50 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,013.50
|
| Rate for Payer: Mercy Care Medicaid |
$8,013.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,013.50
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$2,480.15
|
|
|
Service Code
|
APR-DRG 5662
|
| Hospital Charge Code |
APRDRG5663
|
| Min. Negotiated Rate |
$2,480.15 |
| Max. Negotiated Rate |
$2,480.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,480.15
|
| Rate for Payer: Mercy Care Medicaid |
$2,480.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,480.15
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$1,894.48
|
|
|
Service Code
|
APR-DRG 5661
|
| Hospital Charge Code |
APRDRG5661
|
| Min. Negotiated Rate |
$1,894.48 |
| Max. Negotiated Rate |
$1,894.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,894.48
|
| Rate for Payer: Mercy Care Medicaid |
$1,894.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,894.48
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$2,480.15
|
|
|
Service Code
|
APR-DRG 5662
|
| Hospital Charge Code |
APRDRG5661
|
| Min. Negotiated Rate |
$2,480.15 |
| Max. Negotiated Rate |
$2,480.15 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$2,480.15
|
| Rate for Payer: Mercy Care Medicaid |
$2,480.15
|
| Rate for Payer: NaphCare Correctional Healthcare |
$2,480.15
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$1,894.48
|
|
|
Service Code
|
APR-DRG 5661
|
| Hospital Charge Code |
APRDRG5663
|
| Min. Negotiated Rate |
$1,894.48 |
| Max. Negotiated Rate |
$1,894.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,894.48
|
| Rate for Payer: Mercy Care Medicaid |
$1,894.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,894.48
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$3,676.74
|
|
|
Service Code
|
APR-DRG 5663
|
| Hospital Charge Code |
APRDRG5662
|
| Min. Negotiated Rate |
$3,676.74 |
| Max. Negotiated Rate |
$3,676.74 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$3,676.74
|
| Rate for Payer: Mercy Care Medicaid |
$3,676.74
|
| Rate for Payer: NaphCare Correctional Healthcare |
$3,676.74
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$8,013.50
|
|
|
Service Code
|
APR-DRG 5664
|
| Hospital Charge Code |
APRDRG5661
|
| Min. Negotiated Rate |
$8,013.50 |
| Max. Negotiated Rate |
$8,013.50 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,013.50
|
| Rate for Payer: Mercy Care Medicaid |
$8,013.50
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,013.50
|
|
|
Antepartum Without O.R. Procedure
|
Facility
|
IP
|
$1,894.48
|
|
|
Service Code
|
APR-DRG 5661
|
| Hospital Charge Code |
APRDRG5662
|
| Min. Negotiated Rate |
$1,894.48 |
| Max. Negotiated Rate |
$1,894.48 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$1,894.48
|
| Rate for Payer: Mercy Care Medicaid |
$1,894.48
|
| Rate for Payer: NaphCare Correctional Healthcare |
$1,894.48
|
|
|
Anterior Repair with graft
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT 57267
|
| Hospital Charge Code |
27267805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,174.50 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna of AZ Commercial |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,044.00
|
|
