Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTRO

Facility

IP

$24.00

Service Code	CPT 93270
Hospital Charge Code	24275809
Hospital Revenue Code	521
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Cash Price	$19.20

EXTERNAL VAC GARD SHUT OFF VALVE AND FILTER

Facility

IP

$85.44

Hospital Charge Code	27326453
Hospital Revenue Code	270
Min. Negotiated Rate	$76.90
Max. Negotiated Rate	$76.90
Rate for Payer: Aetna of AZ Commercial	$76.90
Rate for Payer: Cash Price	$68.35

EXTERNAL VAC GARD SHUT OFF VALVE AND FILTER

Facility

OP

$85.44

Hospital Charge Code	27326453
Hospital Revenue Code	270
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$76.90
Rate for Payer: Aetna of AZ Commercial	$76.90
Rate for Payer: Arizona Complete Health Allwell	$13.67
Rate for Payer: Banner UC Health Medicare	$13.67
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$58.10
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$13.67
Rate for Payer: Care1st Health Plan Arizona Medicare	$13.67
Rate for Payer: Cash Price	$68.35
Rate for Payer: Cigna of AZ Commercial	$59.81
Rate for Payer: Devoted Health Medicare	$15.38
Rate for Payer: Humana of AZ Medicare	$13.67
Rate for Payer: Southwest Service Administrators UFCW	$58.10
Rate for Payer: TriWest Medicare	$13.67
Rate for Payer: United Healthcare Commercial	$48.87
Rate for Payer: United Healthcare Medicare	$13.67
Rate for Payer: Veterans Affairs TRICARE	$13.53

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80
Rate for Payer: NaphCare Correctional Healthcare	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24
Rate for Payer: NaphCare Correctional Healthcare	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80
Rate for Payer: NaphCare Correctional Healthcare	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24
Rate for Payer: NaphCare Correctional Healthcare	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24
Rate for Payer: NaphCare Correctional Healthcare	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80
Rate for Payer: NaphCare Correctional Healthcare	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24
Rate for Payer: NaphCare Correctional Healthcare	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80
Rate for Payer: NaphCare Correctional Healthcare	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15
Rate for Payer: NaphCare Correctional Healthcare	$32,993.15

EXTRACRANIAL PROCEDURES WITH CC

Facility

IP

$20,970.73

Service Code	MSDRG 038
Min. Negotiated Rate	$20,970.73
Max. Negotiated Rate	$20,970.73
Rate for Payer: Seven Corners Travel Insurance	$20,970.73

EXTRACRANIAL PROCEDURES WITH MCC

Facility

IP

$42,547.58

Service Code	MSDRG 037
Min. Negotiated Rate	$42,547.58
Max. Negotiated Rate	$42,547.58
Rate for Payer: Seven Corners Travel Insurance	$42,547.58

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

IP

$15,250.40

Service Code	MSDRG 039
Min. Negotiated Rate	$15,250.40
Max. Negotiated Rate	$15,250.40
Rate for Payer: Seven Corners Travel Insurance	$15,250.40

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NR

Facility

IP

$107.00

Service Code	CPT 86235
Hospital Charge Code	23298041
Hospital Revenue Code	301
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Cash Price	$85.60

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NR

Facility

OP

$107.00

Service Code	CPT 86235
Hospital Charge Code	23298041
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Arizona Complete Health Allwell	$17.12
Rate for Payer: Banner UC Health Medicare	$17.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.12
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$69.55
Rate for Payer: Devoted Health Medicare	$19.26
Rate for Payer: Humana of AZ Medicare	$17.12
Rate for Payer: Seven Corners Travel Insurance	$26.00
Rate for Payer: Southwest Service Administrators UFCW	$72.76
Rate for Payer: TriWest Medicare	$17.12
Rate for Payer: United Healthcare Commercial	$61.20
Rate for Payer: United Healthcare Medicare	$17.12
Rate for Payer: Veterans Affairs TRICARE	$16.95

EXTRACTOR STONE 2.8F NTRAP

Facility

IP

$1,686.00

Hospital Charge Code	22354228
Hospital Revenue Code	270
Min. Negotiated Rate	$1,517.40
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Cash Price	$1,348.80

<<
<
217
218
219
220
221
222
223
224
225
226
>
>>