Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Fever And Inflammatory Conditions

Facility

IP

$8,982.13

Service Code	APR-DRG 7224
Hospital Charge Code	APRDRG7224
Min. Negotiated Rate	$8,982.13
Max. Negotiated Rate	$8,982.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,982.13
Rate for Payer: Mercy Care Medicaid	$8,982.13
Rate for Payer: NaphCare Correctional Healthcare	$8,982.13

Fever And Inflammatory Conditions

Facility

IP

$5,346.07

Service Code	APR-DRG 7223
Hospital Charge Code	APRDRG7222
Min. Negotiated Rate	$5,346.07
Max. Negotiated Rate	$5,346.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,346.07
Rate for Payer: Mercy Care Medicaid	$5,346.07
Rate for Payer: NaphCare Correctional Healthcare	$5,346.07

Fever And Inflammatory Conditions

Facility

IP

$2,771.93

Service Code	APR-DRG 7221
Hospital Charge Code	APRDRG7222
Min. Negotiated Rate	$2,771.93
Max. Negotiated Rate	$2,771.93
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,771.93
Rate for Payer: Mercy Care Medicaid	$2,771.93
Rate for Payer: NaphCare Correctional Healthcare	$2,771.93

Fever And Inflammatory Conditions

Facility

IP

$8,982.13

Service Code	APR-DRG 7224
Hospital Charge Code	APRDRG7223
Min. Negotiated Rate	$8,982.13
Max. Negotiated Rate	$8,982.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,982.13
Rate for Payer: Mercy Care Medicaid	$8,982.13
Rate for Payer: NaphCare Correctional Healthcare	$8,982.13

Fever And Inflammatory Conditions

Facility

IP

$2,771.93

Service Code	APR-DRG 7221
Hospital Charge Code	APRDRG7224
Min. Negotiated Rate	$2,771.93
Max. Negotiated Rate	$2,771.93
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,771.93
Rate for Payer: Mercy Care Medicaid	$2,771.93
Rate for Payer: NaphCare Correctional Healthcare	$2,771.93

Fever And Inflammatory Conditions

Facility

IP

$3,953.09

Service Code	APR-DRG 7222
Hospital Charge Code	APRDRG7222
Min. Negotiated Rate	$3,953.09
Max. Negotiated Rate	$3,953.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,953.09
Rate for Payer: Mercy Care Medicaid	$3,953.09
Rate for Payer: NaphCare Correctional Healthcare	$3,953.09

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$11,603.65

Service Code	MSDRG 864
Min. Negotiated Rate	$11,603.65
Max. Negotiated Rate	$11,603.65
Rate for Payer: Seven Corners Travel Insurance	$11,603.65

FFP CPD

Facility

IP

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857708
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

FFP CPD

Facility

OP

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857708
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

FFP Thawed CPD

Facility

OP

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857624
Hospital Revenue Code	390
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Arizona Complete Health Allwell	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$120.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.32
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Devoted Health Medicare	$31.86
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Seven Corners Travel Insurance	$130.21
Rate for Payer: Southwest Service Administrators UFCW	$120.36
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: United Healthcare Commercial	$101.24
Rate for Payer: United Healthcare Medicare	$28.32
Rate for Payer: Veterans Affairs TRICARE	$28.04

FFP Thawed CPD

Facility

IP

$177.00

Service Code	HCPCS P9017
Hospital Charge Code	857624
Hospital Revenue Code	390
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Cash Price	$141.60

FIBER LASER 200 MIC HOLMIUM OLYMP

Facility

OP

$1,032.00

Hospital Charge Code	22773611
Hospital Revenue Code	272
Min. Negotiated Rate	$163.47
Max. Negotiated Rate	$928.80
Rate for Payer: Aetna of AZ Commercial	$928.80
Rate for Payer: Arizona Complete Health Allwell	$165.12
Rate for Payer: Banner UC Health Medicare	$165.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$701.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$165.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$165.12
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cigna of AZ Commercial	$722.40
Rate for Payer: Devoted Health Medicare	$185.76
Rate for Payer: Humana of AZ Medicare	$165.12
Rate for Payer: Southwest Service Administrators UFCW	$701.76
Rate for Payer: TriWest Medicare	$165.12
Rate for Payer: United Healthcare Commercial	$590.30
Rate for Payer: United Healthcare Medicare	$165.12
Rate for Payer: Veterans Affairs TRICARE	$163.47

FIBER LASER 200 MIC HOLMIUM OLYMP

Facility

IP

$1,032.00

Hospital Charge Code	22773611
Hospital Revenue Code	272
Min. Negotiated Rate	$928.80
Max. Negotiated Rate	$928.80
Rate for Payer: Aetna of AZ Commercial	$928.80
Rate for Payer: Cash Price	$825.60

FIBER LASER 273 MIC COOK

Facility

IP

$1,274.00

Hospital Charge Code	22354785
Hospital Revenue Code	270
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$1,146.60
Rate for Payer: Aetna of AZ Commercial	$1,146.60
Rate for Payer: Cash Price	$1,019.20

FIBER LASER 273 MIC COOK

Facility

OP

$1,274.00

Hospital Charge Code	22354785
Hospital Revenue Code	270
Min. Negotiated Rate	$201.80
Max. Negotiated Rate	$1,146.60
Rate for Payer: Aetna of AZ Commercial	$1,146.60
Rate for Payer: Arizona Complete Health Allwell	$203.84
Rate for Payer: Banner UC Health Medicare	$203.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$866.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$203.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$203.84
Rate for Payer: Cash Price	$1,019.20
Rate for Payer: Cigna of AZ Commercial	$891.80
Rate for Payer: Devoted Health Medicare	$229.32
Rate for Payer: Humana of AZ Medicare	$203.84
Rate for Payer: Southwest Service Administrators UFCW	$866.32
Rate for Payer: TriWest Medicare	$203.84
Rate for Payer: United Healthcare Commercial	$728.73
Rate for Payer: United Healthcare Medicare	$203.84
Rate for Payer: Veterans Affairs TRICARE	$201.80

FIBER LASER OPTILITE HOLMIUM 273 COOK

Facility

OP

$1,423.00

Hospital Charge Code	22354786
Hospital Revenue Code	270
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$1,280.70
Rate for Payer: Aetna of AZ Commercial	$1,280.70
Rate for Payer: Arizona Complete Health Allwell	$227.68
Rate for Payer: Banner UC Health Medicare	$227.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$967.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$227.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$227.68
Rate for Payer: Cash Price	$1,138.40
Rate for Payer: Cigna of AZ Commercial	$996.10
Rate for Payer: Devoted Health Medicare	$256.14
Rate for Payer: Humana of AZ Medicare	$227.68
Rate for Payer: Southwest Service Administrators UFCW	$967.64
Rate for Payer: TriWest Medicare	$227.68
Rate for Payer: United Healthcare Commercial	$813.96
Rate for Payer: United Healthcare Medicare	$227.68
Rate for Payer: Veterans Affairs TRICARE	$225.40

FIBER LASER OPTILITE HOLMIUM 273 COOK

Facility

IP

$1,423.00

Hospital Charge Code	22354786
Hospital Revenue Code	270
Min. Negotiated Rate	$1,280.70
Max. Negotiated Rate	$1,280.70
Rate for Payer: Aetna of AZ Commercial	$1,280.70
Rate for Payer: Cash Price	$1,138.40

Fibrinogen

Facility

OP

$139.00

Service Code	CPT 85384
Hospital Charge Code	633728
Hospital Revenue Code	305
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Arizona Complete Health Allwell	$22.24
Rate for Payer: Banner UC Health Medicare	$22.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$94.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.24
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Devoted Health Medicare	$25.02
Rate for Payer: Humana of AZ Medicare	$22.24
Rate for Payer: Seven Corners Travel Insurance	$14.09
Rate for Payer: Southwest Service Administrators UFCW	$94.52
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: United Healthcare Commercial	$79.51
Rate for Payer: United Healthcare Medicare	$22.24
Rate for Payer: Veterans Affairs TRICARE	$22.02

Fibrinogen

Facility

IP

$139.00

Service Code	CPT 85384
Hospital Charge Code	633728
Hospital Revenue Code	305
Min. Negotiated Rate	$125.10
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Cash Price	$111.20

FILTER BLOOD TRANSFUSION 120

Facility

IP

$111.00

Hospital Charge Code	22355515
Hospital Revenue Code	270
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Cash Price	$88.80

FILTER BLOOD TRANSFUSION 120

Facility

OP

$111.00

Hospital Charge Code	22355515
Hospital Revenue Code	270
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Arizona Complete Health Allwell	$17.76
Rate for Payer: Banner UC Health Medicare	$17.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$75.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.76
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Devoted Health Medicare	$19.98
Rate for Payer: Humana of AZ Medicare	$17.76
Rate for Payer: Southwest Service Administrators UFCW	$75.48
Rate for Payer: TriWest Medicare	$17.76
Rate for Payer: United Healthcare Commercial	$63.49
Rate for Payer: United Healthcare Medicare	$17.76
Rate for Payer: Veterans Affairs TRICARE	$17.58

finasteride 5 mg Tab [CQCH]

Facility

IP

$0.13

Service Code	HCPCS S0138
Hospital Charge Code	105922782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Cash Price	$0.11

finasteride 5 mg Tab [CQCH]

Facility

OP

$0.13

Service Code	HCPCS S0138
Hospital Charge Code	105922782
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.07
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

FISTULA PLUG COOK

Facility

OP

$2,854.00

Hospital Charge Code	22921514
Hospital Revenue Code	272
Min. Negotiated Rate	$452.07
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Arizona Complete Health Allwell	$456.64
Rate for Payer: Banner UC Health Medicare	$456.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,940.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$456.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$456.64
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Cigna of AZ Commercial	$1,997.80
Rate for Payer: Devoted Health Medicare	$513.72
Rate for Payer: Humana of AZ Medicare	$456.64
Rate for Payer: Southwest Service Administrators UFCW	$1,940.72
Rate for Payer: TriWest Medicare	$456.64
Rate for Payer: United Healthcare Commercial	$1,632.49
Rate for Payer: United Healthcare Medicare	$456.64
Rate for Payer: Veterans Affairs TRICARE	$452.07

FISTULA PLUG COOK

Facility

IP

$2,854.00

Hospital Charge Code	22921514
Hospital Revenue Code	272
Min. Negotiated Rate	$2,568.60
Max. Negotiated Rate	$2,568.60
Rate for Payer: Aetna of AZ Commercial	$2,568.60
Rate for Payer: Cash Price	$2,283.20

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