|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$5,850.38
|
|
|
Service Code
|
APR-DRG 0491
|
| Hospital Charge Code |
APRDRG0494
|
| Min. Negotiated Rate |
$5,850.38 |
| Max. Negotiated Rate |
$5,850.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,850.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,850.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,850.38
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$12,705.16
|
|
|
Service Code
|
APR-DRG 0492
|
| Hospital Charge Code |
APRDRG0492
|
| Min. Negotiated Rate |
$12,705.16 |
| Max. Negotiated Rate |
$12,705.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,705.16
|
| Rate for Payer: Mercy Care Medicaid |
$12,705.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,705.16
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$16,798.53
|
|
|
Service Code
|
APR-DRG 0493
|
| Hospital Charge Code |
APRDRG0492
|
| Min. Negotiated Rate |
$16,798.53 |
| Max. Negotiated Rate |
$16,798.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,798.53
|
| Rate for Payer: Mercy Care Medicaid |
$16,798.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,798.53
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$16,798.53
|
|
|
Service Code
|
APR-DRG 0493
|
| Hospital Charge Code |
APRDRG0494
|
| Min. Negotiated Rate |
$16,798.53 |
| Max. Negotiated Rate |
$16,798.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,798.53
|
| Rate for Payer: Mercy Care Medicaid |
$16,798.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,798.53
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$5,850.38
|
|
|
Service Code
|
APR-DRG 0491
|
| Hospital Charge Code |
APRDRG0492
|
| Min. Negotiated Rate |
$5,850.38 |
| Max. Negotiated Rate |
$5,850.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,850.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,850.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,850.38
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$5,850.38
|
|
|
Service Code
|
APR-DRG 0491
|
| Hospital Charge Code |
APRDRG0491
|
| Min. Negotiated Rate |
$5,850.38 |
| Max. Negotiated Rate |
$5,850.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,850.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,850.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,850.38
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$27,128.05
|
|
|
Service Code
|
APR-DRG 0494
|
| Hospital Charge Code |
APRDRG0491
|
| Min. Negotiated Rate |
$27,128.05 |
| Max. Negotiated Rate |
$27,128.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,128.05
|
| Rate for Payer: Mercy Care Medicaid |
$27,128.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,128.05
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$5,850.38
|
|
|
Service Code
|
APR-DRG 0491
|
| Hospital Charge Code |
APRDRG0493
|
| Min. Negotiated Rate |
$5,850.38 |
| Max. Negotiated Rate |
$5,850.38 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$5,850.38
|
| Rate for Payer: Mercy Care Medicaid |
$5,850.38
|
| Rate for Payer: NaphCare Correctional Healthcare |
$5,850.38
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$27,128.05
|
|
|
Service Code
|
APR-DRG 0494
|
| Hospital Charge Code |
APRDRG0492
|
| Min. Negotiated Rate |
$27,128.05 |
| Max. Negotiated Rate |
$27,128.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,128.05
|
| Rate for Payer: Mercy Care Medicaid |
$27,128.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,128.05
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$16,798.53
|
|
|
Service Code
|
APR-DRG 0493
|
| Hospital Charge Code |
APRDRG0493
|
| Min. Negotiated Rate |
$16,798.53 |
| Max. Negotiated Rate |
$16,798.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,798.53
|
| Rate for Payer: Mercy Care Medicaid |
$16,798.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,798.53
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$27,128.05
|
|
|
Service Code
|
APR-DRG 0494
|
| Hospital Charge Code |
APRDRG0493
|
| Min. Negotiated Rate |
$27,128.05 |
| Max. Negotiated Rate |
$27,128.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,128.05
|
| Rate for Payer: Mercy Care Medicaid |
$27,128.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,128.05
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$12,705.16
|
|
|
Service Code
|
APR-DRG 0492
|
| Hospital Charge Code |
APRDRG0491
|
| Min. Negotiated Rate |
$12,705.16 |
| Max. Negotiated Rate |
$12,705.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,705.16
|
| Rate for Payer: Mercy Care Medicaid |
$12,705.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,705.16
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$12,705.16
|
|
|
Service Code
|
APR-DRG 0492
|
| Hospital Charge Code |
APRDRG0493
|
| Min. Negotiated Rate |
$12,705.16 |
| Max. Negotiated Rate |
$12,705.16 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$12,705.16
|
| Rate for Payer: Mercy Care Medicaid |
$12,705.16
|
| Rate for Payer: NaphCare Correctional Healthcare |
$12,705.16
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$16,798.53
|
|
|
Service Code
|
APR-DRG 0493
|
| Hospital Charge Code |
APRDRG0491
|
| Min. Negotiated Rate |
$16,798.53 |
| Max. Negotiated Rate |
$16,798.53 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$16,798.53
|
| Rate for Payer: Mercy Care Medicaid |
$16,798.53
|
| Rate for Payer: NaphCare Correctional Healthcare |
$16,798.53
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
IP
|
$27,128.05
|
|
|
Service Code
|
APR-DRG 0494
|
| Hospital Charge Code |
APRDRG0494
|
| Min. Negotiated Rate |
$27,128.05 |
| Max. Negotiated Rate |
$27,128.05 |
| Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice |
$27,128.05
|
| Rate for Payer: Mercy Care Medicaid |
$27,128.05
|
| Rate for Payer: NaphCare Correctional Healthcare |
$27,128.05
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$33,333.92
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$33,333.92 |
| Max. Negotiated Rate |
$33,333.92 |
| Rate for Payer: Seven Corners Travel Insurance |
$33,333.92
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$45,485.22
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$45,485.22 |
| Max. Negotiated Rate |
$45,485.22 |
| Rate for Payer: Seven Corners Travel Insurance |
$45,485.22
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$33,333.92
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$33,333.92 |
| Max. Negotiated Rate |
$33,333.92 |
| Rate for Payer: Seven Corners Travel Insurance |
$33,333.92
|
|
|
BAG BILE
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
22355157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of AZ Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
|
|
BAG BILE
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
22355157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of AZ Commercial |
$52.20
|
| Rate for Payer: Arizona Complete Health Allwell |
$9.28
|
| Rate for Payer: Banner UC Health Medicare |
$9.28
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$9.28
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$9.28
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cigna of AZ Commercial |
$40.60
|
| Rate for Payer: Devoted Health Medicare |
$10.44
|
| Rate for Payer: Humana of AZ Medicare |
$9.28
|
| Rate for Payer: Southwest Service Administrators UFCW |
$39.44
|
| Rate for Payer: TriWest Medicare |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$33.18
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: Veterans Affairs TRICARE |
$9.19
|
|
|
BAG CLOSED DRNG
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A4357
|
| Hospital Charge Code |
22355306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$28.80
|
|
|
BAG CLOSED DRNG
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A4357
|
| Hospital Charge Code |
22355306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of AZ Commercial |
$32.40
|
| Rate for Payer: Arizona Complete Health Allwell |
$5.76
|
| Rate for Payer: Banner UC Health Medicare |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$5.76
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$5.76
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of AZ Commercial |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$6.48
|
| Rate for Payer: Humana of AZ Medicare |
$5.76
|
| Rate for Payer: Southwest Service Administrators UFCW |
$24.48
|
| Rate for Payer: TriWest Medicare |
$5.76
|
| Rate for Payer: United Healthcare Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
| Rate for Payer: Veterans Affairs TRICARE |
$5.70
|
|
|
BAG ICE DISP
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
22355402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Arizona Complete Health Allwell |
$1.44
|
| Rate for Payer: Banner UC Health Medicare |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$1.44
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$1.44
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of AZ Commercial |
$6.30
|
| Rate for Payer: Devoted Health Medicare |
$1.62
|
| Rate for Payer: Humana of AZ Medicare |
$1.44
|
| Rate for Payer: Southwest Service Administrators UFCW |
$6.12
|
| Rate for Payer: TriWest Medicare |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$5.15
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: Veterans Affairs TRICARE |
$1.43
|
|
|
BAG ICE DISP
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
22355402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of AZ Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$7.20
|
|
|
BAG PREM LEG DISPOSABLE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
22354156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of AZ Commercial |
$13.50
|
| Rate for Payer: Arizona Complete Health Allwell |
$2.40
|
| Rate for Payer: Banner UC Health Medicare |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Commercial |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of Arizona Medicare |
$2.40
|
| Rate for Payer: Care1st Health Plan Arizona Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of AZ Commercial |
$10.50
|
| Rate for Payer: Devoted Health Medicare |
$2.70
|
| Rate for Payer: Humana of AZ Medicare |
$2.40
|
| Rate for Payer: Southwest Service Administrators UFCW |
$10.20
|
| Rate for Payer: TriWest Medicare |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: Veterans Affairs TRICARE |
$2.38
|
|
