|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$12,373.40
|
|
|
Service Code
|
APR-DRG 1772
|
| Hospital Charge Code |
APRDRG1771
|
| Min. Negotiated Rate |
$12,373.40 |
| Max. Negotiated Rate |
$12,373.40 |
| Rate for Payer: AHCCCS Medicaid |
$12,373.40
|
| Rate for Payer: Allwell Medicaid |
$12,373.40
|
| Rate for Payer: AZCH Complete Medicaid |
$12,373.40
|
| Rate for Payer: Banner UC Health Medicaid |
$12,373.40
|
| Rate for Payer: Mercy Care Medicaid |
$12,373.40
|
|
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
Facility
|
IP
|
$23,051.51
|
|
|
Service Code
|
APR-DRG 1774
|
| Hospital Charge Code |
APRDRG1773
|
| Min. Negotiated Rate |
$23,051.51 |
| Max. Negotiated Rate |
$23,051.51 |
| Rate for Payer: AHCCCS Medicaid |
$23,051.51
|
| Rate for Payer: Allwell Medicaid |
$23,051.51
|
| Rate for Payer: AZCH Complete Medicaid |
$23,051.51
|
| Rate for Payer: Banner UC Health Medicaid |
$23,051.51
|
| Rate for Payer: Mercy Care Medicaid |
$23,051.51
|
|
|
Cardiac Panel 2
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
2483894
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna of AZ Commercial |
$265.50
|
| Rate for Payer: Bisbee Police All Plans |
$76.70
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Self Pay Self Pay |
$236.00
|
|
|
Cardiac Panel 2
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
2483894
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna of AZ Commercial |
$265.50
|
| Rate for Payer: Aetna of AZ Medicare |
$82.60
|
| Rate for Payer: Allwell Medicare |
$47.20
|
| Rate for Payer: Amerigroup Medicare |
$47.20
|
| Rate for Payer: APIPA Medicare/Medicaid |
$110.18
|
| Rate for Payer: AZCH Complete Medicare |
$47.20
|
| Rate for Payer: Banner UC Health Medicare |
$47.20
|
| Rate for Payer: Bisbee Police All Plans |
$76.70
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna of AZ Commercial |
$191.75
|
| Rate for Payer: Copperpoint Commercial |
$73.01
|
| Rate for Payer: Health Net of AZ Commercial |
$177.00
|
| Rate for Payer: Health Net of AZ Medicare |
$82.60
|
| Rate for Payer: Humana of AZ Medicare |
$47.20
|
| Rate for Payer: Self Pay Self Pay |
$236.00
|
| Rate for Payer: TriWest Medicare |
$47.20
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$171.99
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$53.10
|
|
|
Cardiac Panel Standard
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
22141052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna of AZ Commercial |
$279.90
|
| Rate for Payer: Bisbee Police All Plans |
$80.86
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Self Pay Self Pay |
$248.80
|
|
|
Cardiac Panel Standard
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
22141052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.76 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna of AZ Commercial |
$279.90
|
| Rate for Payer: Aetna of AZ Medicare |
$87.08
|
| Rate for Payer: Allwell Medicare |
$49.76
|
| Rate for Payer: Amerigroup Medicare |
$49.76
|
| Rate for Payer: APIPA Medicare/Medicaid |
$116.16
|
| Rate for Payer: AZCH Complete Medicare |
$49.76
|
| Rate for Payer: Banner UC Health Medicare |
$49.76
|
| Rate for Payer: Bisbee Police All Plans |
$80.86
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$211.48
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cigna of AZ Commercial |
$202.15
|
| Rate for Payer: Copperpoint Commercial |
$76.97
|
| Rate for Payer: Health Net of AZ Commercial |
$186.60
|
| Rate for Payer: Health Net of AZ Medicare |
$87.08
|
| Rate for Payer: Humana of AZ Medicare |
$49.76
|
| Rate for Payer: Self Pay Self Pay |
$248.80
|
| Rate for Payer: TriWest Medicare |
$49.76
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$181.31
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$55.98
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$3,734.25
|
|
|
Service Code
|
APR-DRG 2001
|
| Hospital Charge Code |
APRDRG2002
|
| Min. Negotiated Rate |
$3,734.25 |
| Max. Negotiated Rate |
$3,734.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,734.25
|
| Rate for Payer: Allwell Medicaid |
$3,734.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,734.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,734.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,734.25
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$6,734.14
|
|
|
Service Code
|
APR-DRG 2003
|
| Hospital Charge Code |
APRDRG2004
|
| Min. Negotiated Rate |
$6,734.14 |
| Max. Negotiated Rate |
$6,734.14 |
| Rate for Payer: AHCCCS Medicaid |
$6,734.14
|
| Rate for Payer: Allwell Medicaid |
$6,734.14
|
| Rate for Payer: AZCH Complete Medicaid |
$6,734.14
|
| Rate for Payer: Banner UC Health Medicaid |
$6,734.14
|
| Rate for Payer: Mercy Care Medicaid |
$6,734.14
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$3,734.25
|
|
|
Service Code
|
APR-DRG 2001
|
| Hospital Charge Code |
APRDRG2003
|
| Min. Negotiated Rate |
$3,734.25 |
| Max. Negotiated Rate |
$3,734.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,734.25
|
| Rate for Payer: Allwell Medicaid |
$3,734.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,734.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,734.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,734.25
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$4,726.03
|
|
|
Service Code
|
APR-DRG 2002
|
| Hospital Charge Code |
APRDRG2002
|
| Min. Negotiated Rate |
$4,726.03 |
| Max. Negotiated Rate |
$4,726.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,726.03
|
| Rate for Payer: Allwell Medicaid |
$4,726.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,726.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,726.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,726.03
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$6,734.14
|
|
|
Service Code
|
APR-DRG 2003
|
| Hospital Charge Code |
APRDRG2001
|
| Min. Negotiated Rate |
$6,734.14 |
| Max. Negotiated Rate |
$6,734.14 |
| Rate for Payer: AHCCCS Medicaid |
$6,734.14
|
| Rate for Payer: Allwell Medicaid |
$6,734.14
|
| Rate for Payer: AZCH Complete Medicaid |
$6,734.14
|
| Rate for Payer: Banner UC Health Medicaid |
$6,734.14
|
| Rate for Payer: Mercy Care Medicaid |
$6,734.14
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$6,734.14
|
|
|
Service Code
|
APR-DRG 2003
|
| Hospital Charge Code |
APRDRG2003
|
| Min. Negotiated Rate |
$6,734.14 |
| Max. Negotiated Rate |
$6,734.14 |
| Rate for Payer: AHCCCS Medicaid |
$6,734.14
|
| Rate for Payer: Allwell Medicaid |
$6,734.14
|
| Rate for Payer: AZCH Complete Medicaid |
$6,734.14
|
| Rate for Payer: Banner UC Health Medicaid |
$6,734.14
|
| Rate for Payer: Mercy Care Medicaid |
$6,734.14
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$6,734.14
|
|
|
Service Code
|
APR-DRG 2003
|
| Hospital Charge Code |
APRDRG2002
|
| Min. Negotiated Rate |
$6,734.14 |
| Max. Negotiated Rate |
$6,734.14 |
| Rate for Payer: AHCCCS Medicaid |
$6,734.14
|
| Rate for Payer: Allwell Medicaid |
$6,734.14
|
| Rate for Payer: AZCH Complete Medicaid |
$6,734.14
|
| Rate for Payer: Banner UC Health Medicaid |
$6,734.14
|
| Rate for Payer: Mercy Care Medicaid |
$6,734.14
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$4,726.03
|
|
|
Service Code
|
APR-DRG 2002
|
| Hospital Charge Code |
APRDRG2004
|
| Min. Negotiated Rate |
$4,726.03 |
| Max. Negotiated Rate |
$4,726.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,726.03
|
| Rate for Payer: Allwell Medicaid |
$4,726.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,726.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,726.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,726.03
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$4,726.03
|
|
|
Service Code
|
APR-DRG 2002
|
| Hospital Charge Code |
APRDRG2003
|
| Min. Negotiated Rate |
$4,726.03 |
| Max. Negotiated Rate |
$4,726.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,726.03
|
| Rate for Payer: Allwell Medicaid |
$4,726.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,726.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,726.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,726.03
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$12,416.88
|
|
|
Service Code
|
APR-DRG 2004
|
| Hospital Charge Code |
APRDRG2001
|
| Min. Negotiated Rate |
$12,416.88 |
| Max. Negotiated Rate |
$12,416.88 |
| Rate for Payer: AHCCCS Medicaid |
$12,416.88
|
| Rate for Payer: Allwell Medicaid |
$12,416.88
|
| Rate for Payer: AZCH Complete Medicaid |
$12,416.88
|
| Rate for Payer: Banner UC Health Medicaid |
$12,416.88
|
| Rate for Payer: Mercy Care Medicaid |
$12,416.88
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$12,416.88
|
|
|
Service Code
|
APR-DRG 2004
|
| Hospital Charge Code |
APRDRG2003
|
| Min. Negotiated Rate |
$12,416.88 |
| Max. Negotiated Rate |
$12,416.88 |
| Rate for Payer: AHCCCS Medicaid |
$12,416.88
|
| Rate for Payer: Allwell Medicaid |
$12,416.88
|
| Rate for Payer: AZCH Complete Medicaid |
$12,416.88
|
| Rate for Payer: Banner UC Health Medicaid |
$12,416.88
|
| Rate for Payer: Mercy Care Medicaid |
$12,416.88
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$12,416.88
|
|
|
Service Code
|
APR-DRG 2004
|
| Hospital Charge Code |
APRDRG2002
|
| Min. Negotiated Rate |
$12,416.88 |
| Max. Negotiated Rate |
$12,416.88 |
| Rate for Payer: AHCCCS Medicaid |
$12,416.88
|
| Rate for Payer: Allwell Medicaid |
$12,416.88
|
| Rate for Payer: AZCH Complete Medicaid |
$12,416.88
|
| Rate for Payer: Banner UC Health Medicaid |
$12,416.88
|
| Rate for Payer: Mercy Care Medicaid |
$12,416.88
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$4,726.03
|
|
|
Service Code
|
APR-DRG 2002
|
| Hospital Charge Code |
APRDRG2001
|
| Min. Negotiated Rate |
$4,726.03 |
| Max. Negotiated Rate |
$4,726.03 |
| Rate for Payer: AHCCCS Medicaid |
$4,726.03
|
| Rate for Payer: Allwell Medicaid |
$4,726.03
|
| Rate for Payer: AZCH Complete Medicaid |
$4,726.03
|
| Rate for Payer: Banner UC Health Medicaid |
$4,726.03
|
| Rate for Payer: Mercy Care Medicaid |
$4,726.03
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$12,416.88
|
|
|
Service Code
|
APR-DRG 2004
|
| Hospital Charge Code |
APRDRG2004
|
| Min. Negotiated Rate |
$12,416.88 |
| Max. Negotiated Rate |
$12,416.88 |
| Rate for Payer: AHCCCS Medicaid |
$12,416.88
|
| Rate for Payer: Allwell Medicaid |
$12,416.88
|
| Rate for Payer: AZCH Complete Medicaid |
$12,416.88
|
| Rate for Payer: Banner UC Health Medicaid |
$12,416.88
|
| Rate for Payer: Mercy Care Medicaid |
$12,416.88
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$3,734.25
|
|
|
Service Code
|
APR-DRG 2001
|
| Hospital Charge Code |
APRDRG2004
|
| Min. Negotiated Rate |
$3,734.25 |
| Max. Negotiated Rate |
$3,734.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,734.25
|
| Rate for Payer: Allwell Medicaid |
$3,734.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,734.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,734.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,734.25
|
|
|
Cardiac Structural And Valvular Disorders
|
Facility
|
IP
|
$3,734.25
|
|
|
Service Code
|
APR-DRG 2001
|
| Hospital Charge Code |
APRDRG2001
|
| Min. Negotiated Rate |
$3,734.25 |
| Max. Negotiated Rate |
$3,734.25 |
| Rate for Payer: AHCCCS Medicaid |
$3,734.25
|
| Rate for Payer: Allwell Medicaid |
$3,734.25
|
| Rate for Payer: AZCH Complete Medicaid |
$3,734.25
|
| Rate for Payer: Banner UC Health Medicaid |
$3,734.25
|
| Rate for Payer: Mercy Care Medicaid |
$3,734.25
|
|
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$42,829.59
|
|
|
Service Code
|
APR-DRG 1623
|
| Hospital Charge Code |
APRDRG1622
|
| Min. Negotiated Rate |
$42,829.59 |
| Max. Negotiated Rate |
$42,829.59 |
| Rate for Payer: AHCCCS Medicaid |
$42,829.59
|
| Rate for Payer: Allwell Medicaid |
$42,829.59
|
| Rate for Payer: AZCH Complete Medicaid |
$42,829.59
|
| Rate for Payer: Banner UC Health Medicaid |
$42,829.59
|
| Rate for Payer: Mercy Care Medicaid |
$42,829.59
|
|
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$42,829.59
|
|
|
Service Code
|
APR-DRG 1623
|
| Hospital Charge Code |
APRDRG1623
|
| Min. Negotiated Rate |
$42,829.59 |
| Max. Negotiated Rate |
$42,829.59 |
| Rate for Payer: AHCCCS Medicaid |
$42,829.59
|
| Rate for Payer: Allwell Medicaid |
$42,829.59
|
| Rate for Payer: AZCH Complete Medicaid |
$42,829.59
|
| Rate for Payer: Banner UC Health Medicaid |
$42,829.59
|
| Rate for Payer: Mercy Care Medicaid |
$42,829.59
|
|
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
Facility
|
IP
|
$66,036.11
|
|
|
Service Code
|
APR-DRG 1624
|
| Hospital Charge Code |
APRDRG1621
|
| Min. Negotiated Rate |
$66,036.11 |
| Max. Negotiated Rate |
$66,036.11 |
| Rate for Payer: AHCCCS Medicaid |
$66,036.11
|
| Rate for Payer: Allwell Medicaid |
$66,036.11
|
| Rate for Payer: AZCH Complete Medicaid |
$66,036.11
|
| Rate for Payer: Banner UC Health Medicaid |
$66,036.11
|
| Rate for Payer: Mercy Care Medicaid |
$66,036.11
|
|
