|
Appendectomy With Complex Principal Diagnosis
|
Facility
|
IP
|
$8,406.98
|
|
|
Service Code
|
APR-DRG 2332
|
| Hospital Charge Code |
APRDRG2334
|
| Min. Negotiated Rate |
$8,406.98 |
| Max. Negotiated Rate |
$8,406.98 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,406.98
|
| Rate for Payer: Mercy Care Medicaid |
$8,406.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,406.98
|
|
|
Appendectomy With Complex Principal Diagnosis
|
Facility
|
IP
|
$8,406.98
|
|
|
Service Code
|
APR-DRG 2332
|
| Hospital Charge Code |
APRDRG2333
|
| Min. Negotiated Rate |
$8,406.98 |
| Max. Negotiated Rate |
$8,406.98 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$8,406.98
|
| Rate for Payer: Mercy Care Medicaid |
$8,406.98
|
| Rate for Payer: NaphCare Correctional Healthcare |
$8,406.98
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$7,213.20
|
|
|
Service Code
|
APR-DRG 2342
|
| Hospital Charge Code |
APRDRG2341
|
| Min. Negotiated Rate |
$7,213.20 |
| Max. Negotiated Rate |
$7,213.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,213.20
|
| Rate for Payer: Mercy Care Medicaid |
$7,213.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,213.20
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$10,755.97
|
|
|
Service Code
|
APR-DRG 2343
|
| Hospital Charge Code |
APRDRG2343
|
| Min. Negotiated Rate |
$10,755.97 |
| Max. Negotiated Rate |
$10,755.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,755.97
|
| Rate for Payer: Mercy Care Medicaid |
$10,755.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,755.97
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$5,804.79
|
|
|
Service Code
|
APR-DRG 2341
|
| Hospital Charge Code |
APRDRG2341
|
| Min. Negotiated Rate |
$5,804.79 |
| Max. Negotiated Rate |
$5,804.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,804.79
|
| Rate for Payer: Mercy Care Medicaid |
$5,804.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,804.79
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$7,213.20
|
|
|
Service Code
|
APR-DRG 2342
|
| Hospital Charge Code |
APRDRG2343
|
| Min. Negotiated Rate |
$7,213.20 |
| Max. Negotiated Rate |
$7,213.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,213.20
|
| Rate for Payer: Mercy Care Medicaid |
$7,213.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,213.20
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$5,804.79
|
|
|
Service Code
|
APR-DRG 2341
|
| Hospital Charge Code |
APRDRG2343
|
| Min. Negotiated Rate |
$5,804.79 |
| Max. Negotiated Rate |
$5,804.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,804.79
|
| Rate for Payer: Mercy Care Medicaid |
$5,804.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,804.79
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$7,213.20
|
|
|
Service Code
|
APR-DRG 2342
|
| Hospital Charge Code |
APRDRG2344
|
| Min. Negotiated Rate |
$7,213.20 |
| Max. Negotiated Rate |
$7,213.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,213.20
|
| Rate for Payer: Mercy Care Medicaid |
$7,213.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,213.20
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$20,453.53
|
|
|
Service Code
|
APR-DRG 2344
|
| Hospital Charge Code |
APRDRG2344
|
| Min. Negotiated Rate |
$20,453.53 |
| Max. Negotiated Rate |
$20,453.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$20,453.53
|
| Rate for Payer: Mercy Care Medicaid |
$20,453.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$20,453.53
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$20,453.53
|
|
|
Service Code
|
APR-DRG 2344
|
| Hospital Charge Code |
APRDRG2341
|
| Min. Negotiated Rate |
$20,453.53 |
| Max. Negotiated Rate |
$20,453.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$20,453.53
|
| Rate for Payer: Mercy Care Medicaid |
$20,453.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$20,453.53
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$10,755.97
|
|
|
Service Code
|
APR-DRG 2343
|
| Hospital Charge Code |
APRDRG2342
|
| Min. Negotiated Rate |
$10,755.97 |
| Max. Negotiated Rate |
$10,755.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,755.97
|
| Rate for Payer: Mercy Care Medicaid |
$10,755.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,755.97
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$5,804.79
|
|
|
Service Code
|
APR-DRG 2341
|
| Hospital Charge Code |
APRDRG2344
|
| Min. Negotiated Rate |
$5,804.79 |
| Max. Negotiated Rate |
$5,804.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,804.79
|
| Rate for Payer: Mercy Care Medicaid |
$5,804.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,804.79
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$7,213.20
|
|
|
Service Code
|
APR-DRG 2342
|
| Hospital Charge Code |
APRDRG2342
|
| Min. Negotiated Rate |
$7,213.20 |
| Max. Negotiated Rate |
$7,213.20 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$7,213.20
|
| Rate for Payer: Mercy Care Medicaid |
$7,213.20
|
| Rate for Payer: NaphCare Correctional Healthcare |
$7,213.20
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$20,453.53
|
|
|
Service Code
|
APR-DRG 2344
|
| Hospital Charge Code |
APRDRG2343
|
| Min. Negotiated Rate |
$20,453.53 |
| Max. Negotiated Rate |
$20,453.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$20,453.53
|
| Rate for Payer: Mercy Care Medicaid |
$20,453.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$20,453.53
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$10,755.97
|
|
|
Service Code
|
APR-DRG 2343
|
| Hospital Charge Code |
APRDRG2341
|
| Min. Negotiated Rate |
$10,755.97 |
| Max. Negotiated Rate |
$10,755.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,755.97
|
| Rate for Payer: Mercy Care Medicaid |
$10,755.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,755.97
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$5,804.79
|
|
|
Service Code
|
APR-DRG 2341
|
| Hospital Charge Code |
APRDRG2342
|
| Min. Negotiated Rate |
$5,804.79 |
| Max. Negotiated Rate |
$5,804.79 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,804.79
|
| Rate for Payer: Mercy Care Medicaid |
$5,804.79
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,804.79
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$10,755.97
|
|
|
Service Code
|
APR-DRG 2343
|
| Hospital Charge Code |
APRDRG2344
|
| Min. Negotiated Rate |
$10,755.97 |
| Max. Negotiated Rate |
$10,755.97 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$10,755.97
|
| Rate for Payer: Mercy Care Medicaid |
$10,755.97
|
| Rate for Payer: NaphCare Correctional Healthcare |
$10,755.97
|
|
|
Appendectomy Without Complex Principal Diagnosis
|
Facility
|
IP
|
$20,453.53
|
|
|
Service Code
|
APR-DRG 2344
|
| Hospital Charge Code |
APRDRG2342
|
| Min. Negotiated Rate |
$20,453.53 |
| Max. Negotiated Rate |
$20,453.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$20,453.53
|
| Rate for Payer: Mercy Care Medicaid |
$20,453.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$20,453.53
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$19,561.99
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$19,561.99 |
| Max. Negotiated Rate |
$19,561.99 |
| Rate for Payer: Seven Corners Travel Insurance |
$19,561.99
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$30,952.03
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$30,952.03 |
| Max. Negotiated Rate |
$30,952.03 |
| Rate for Payer: Seven Corners Travel Insurance |
$30,952.03
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,860.14
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$14,860.14 |
| Max. Negotiated Rate |
$14,860.14 |
| Rate for Payer: Seven Corners Travel Insurance |
$14,860.14
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS
|
Facility
|
IP
|
$4,586.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
23922976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,127.40 |
| Max. Negotiated Rate |
$4,127.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,127.40
|
| Rate for Payer: Cash Price |
$3,668.80
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS
|
Facility
|
OP
|
$4,586.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
23922976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$4,127.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,127.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$733.76
|
| Rate for Payer: Banner UC Health Medicare |
$733.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$3,118.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$733.76
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$733.76
|
| Rate for Payer: Cash Price |
$3,668.80
|
| Rate for Payer: Cash Price |
$3,668.80
|
| Rate for Payer: Cigna of AZ Commercial |
$3,210.20
|
| Rate for Payer: Devoted Health Medicare |
$825.48
|
| Rate for Payer: Humana of AZ Medicare |
$733.76
|
| Rate for Payer: Mercy Care Medicaid |
$66.60
|
| Rate for Payer: NaphCare Correctional Healthcare |
$66.60
|
| Rate for Payer: Seven Corners Travel Insurance |
$1,143.54
|
| Rate for Payer: Southwest Service Administrators UFCW |
$3,118.48
|
| Rate for Payer: TriWest Medicare |
$733.76
|
| Rate for Payer: United Healthcare Commercial |
$2,623.19
|
| Rate for Payer: United Healthcare Medicare |
$733.76
|
| Rate for Payer: United Healthcare New Mexico Commercial |
$871.34
|
| Rate for Payer: Veterans Affairs TRICARE |
$726.42
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T
|
Facility
|
IP
|
$4,586.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
23922975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,127.40 |
| Max. Negotiated Rate |
$4,127.40 |
| Rate for Payer: Aetna of AZ Commercial |
$4,127.40
|
| Rate for Payer: Cash Price |
$3,668.80
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, T
|
Facility
|
IP
|
$3,972.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
23634011
|
| Min. Negotiated Rate |
$3,574.80 |
| Max. Negotiated Rate |
$3,574.80 |
| Rate for Payer: Aetna of AZ Commercial |
$3,574.80
|
| Rate for Payer: Cash Price |
$3,177.60
|
|
