Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Knee And Lower Leg Procedures Except Foot

Facility

IP

$11,014.79

Service Code	APR-DRG 3132
Hospital Charge Code	APRDRG3133
Min. Negotiated Rate	$11,014.79
Max. Negotiated Rate	$11,014.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,014.79
Rate for Payer: Mercy Care Medicaid	$11,014.79
Rate for Payer: NaphCare Correctional Healthcare	$11,014.79

Knee And Lower Leg Procedures Except Foot

Facility

IP

$8,129.93

Service Code	APR-DRG 3131
Hospital Charge Code	APRDRG3133
Min. Negotiated Rate	$8,129.93
Max. Negotiated Rate	$8,129.93
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,129.93
Rate for Payer: Mercy Care Medicaid	$8,129.93
Rate for Payer: NaphCare Correctional Healthcare	$8,129.93

Knee And Lower Leg Procedures Except Foot

Facility

IP

$28,088.97

Service Code	APR-DRG 3134
Hospital Charge Code	APRDRG3131
Min. Negotiated Rate	$28,088.97
Max. Negotiated Rate	$28,088.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,088.97
Rate for Payer: Mercy Care Medicaid	$28,088.97
Rate for Payer: NaphCare Correctional Healthcare	$28,088.97

Knee And Lower Leg Procedures Except Foot

Facility

IP

$28,088.97

Service Code	APR-DRG 3134
Hospital Charge Code	APRDRG3134
Min. Negotiated Rate	$28,088.97
Max. Negotiated Rate	$28,088.97
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,088.97
Rate for Payer: Mercy Care Medicaid	$28,088.97
Rate for Payer: NaphCare Correctional Healthcare	$28,088.97

Knee And Lower Leg Procedures Except Foot

Facility

IP

$17,227.09

Service Code	APR-DRG 3133
Hospital Charge Code	APRDRG3134
Min. Negotiated Rate	$17,227.09
Max. Negotiated Rate	$17,227.09
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,227.09
Rate for Payer: Mercy Care Medicaid	$17,227.09
Rate for Payer: NaphCare Correctional Healthcare	$17,227.09

Knee And Lower Leg Procedures Except Foot

Facility

IP

$11,014.79

Service Code	APR-DRG 3132
Hospital Charge Code	APRDRG3134
Min. Negotiated Rate	$11,014.79
Max. Negotiated Rate	$11,014.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,014.79
Rate for Payer: Mercy Care Medicaid	$11,014.79
Rate for Payer: NaphCare Correctional Healthcare	$11,014.79

Knee Immobilizer

Facility

OP

$266.00

Service Code	HCPCS L1830
Hospital Charge Code	1549628
Hospital Revenue Code	521
Min. Negotiated Rate	$42.13
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Arizona Complete Health Allwell	$42.56
Rate for Payer: Banner UC Health Medicare	$42.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$180.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.56
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cigna of AZ Commercial	$186.20
Rate for Payer: Devoted Health Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$42.56
Rate for Payer: Southwest Service Administrators UFCW	$180.88
Rate for Payer: TriWest Medicare	$42.56
Rate for Payer: United Healthcare Commercial	$152.15
Rate for Payer: United Healthcare Medicare	$42.56
Rate for Payer: Veterans Affairs TRICARE	$42.13

Knee Immobilizer

Facility

IP

$266.00

Service Code	HCPCS L1830
Hospital Charge Code	1549628
Hospital Revenue Code	521
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Cash Price	$212.80

KNEE IMMOBILIZER 16

Facility

IP

$78.00

Hospital Charge Code	22354185
Hospital Revenue Code	270
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Cash Price	$62.40

KNEE IMMOBILIZER 16

Facility

OP

$78.00

Hospital Charge Code	22354185
Hospital Revenue Code	270
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Arizona Complete Health Allwell	$12.48
Rate for Payer: Banner UC Health Medicare	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$53.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.48
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Humana of AZ Medicare	$12.48
Rate for Payer: Southwest Service Administrators UFCW	$53.04
Rate for Payer: TriWest Medicare	$12.48
Rate for Payer: United Healthcare Commercial	$44.62
Rate for Payer: United Healthcare Medicare	$12.48
Rate for Payer: Veterans Affairs TRICARE	$12.36

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

IP

$22,861.53

Service Code	MSDRG 488
Min. Negotiated Rate	$22,861.53
Max. Negotiated Rate	$22,861.53
Rate for Payer: Seven Corners Travel Insurance	$22,861.53

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

IP

$14,506.60

Service Code	MSDRG 489
Min. Negotiated Rate	$14,506.60
Max. Negotiated Rate	$14,506.60
Rate for Payer: Seven Corners Travel Insurance	$14,506.60

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

IP

$27,025.68

Service Code	MSDRG 486
Min. Negotiated Rate	$27,025.68
Max. Negotiated Rate	$27,025.68
Rate for Payer: Seven Corners Travel Insurance	$27,025.68

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

IP

$41,707.48

Service Code	MSDRG 485
Min. Negotiated Rate	$41,707.48
Max. Negotiated Rate	$41,707.48
Rate for Payer: Seven Corners Travel Insurance	$41,707.48

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

IP

$20,241.78

Service Code	MSDRG 487
Min. Negotiated Rate	$20,241.78
Max. Negotiated Rate	$20,241.78
Rate for Payer: Seven Corners Travel Insurance	$20,241.78

Ko Elastic Knee Cap

Facility

IP

$128.00

Service Code	HCPCS L1825
Hospital Charge Code	1902189
Hospital Revenue Code	521
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Cash Price	$102.40

Ko Elastic Knee Cap

Facility

OP

$128.00

Service Code	HCPCS L1825
Hospital Charge Code	1902189
Hospital Revenue Code	521
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna of AZ Commercial	$115.20
Rate for Payer: Arizona Complete Health Allwell	$20.48
Rate for Payer: Banner UC Health Medicare	$20.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.48
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cigna of AZ Commercial	$89.60
Rate for Payer: Devoted Health Medicare	$23.04
Rate for Payer: Humana of AZ Medicare	$20.48
Rate for Payer: Southwest Service Administrators UFCW	$87.04
Rate for Payer: TriWest Medicare	$20.48
Rate for Payer: United Healthcare Commercial	$73.22
Rate for Payer: United Healthcare Medicare	$20.48
Rate for Payer: Veterans Affairs TRICARE	$20.28

KWIRE 100MM ONE BLUNT

Facility

OP

$168.00

Hospital Charge Code	27341813
Hospital Revenue Code	270
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Arizona Complete Health Allwell	$26.88
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.88
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$117.60
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Southwest Service Administrators UFCW	$114.24
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: United Healthcare Commercial	$96.10
Rate for Payer: United Healthcare Medicare	$26.88
Rate for Payer: Veterans Affairs TRICARE	$26.61

KWIRE 100MM ONE BLUNT

Facility

IP

$168.00

Hospital Charge Code	27341813
Hospital Revenue Code	270
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Cash Price	$134.40

K WIRE DOUBLE TROCARE 6 IN

Facility

IP

$300.00

Hospital Charge Code	29522628
Hospital Revenue Code	270
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Cash Price	$240.00

K WIRE DOUBLE TROCARE 6 IN

Facility

OP

$300.00

Hospital Charge Code	29522628
Hospital Revenue Code	270
Min. Negotiated Rate	$47.52
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna of AZ Commercial	$270.00
Rate for Payer: Arizona Complete Health Allwell	$48.00
Rate for Payer: Banner UC Health Medicare	$48.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$204.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cigna of AZ Commercial	$210.00
Rate for Payer: Devoted Health Medicare	$54.00
Rate for Payer: Humana of AZ Medicare	$48.00
Rate for Payer: Southwest Service Administrators UFCW	$204.00
Rate for Payer: TriWest Medicare	$48.00
Rate for Payer: United Healthcare Commercial	$171.60
Rate for Payer: United Healthcare Medicare	$48.00
Rate for Payer: Veterans Affairs TRICARE	$47.52

KWIRE SMOOTH DOUBLE TORCAR .45INX9IN

Facility

OP

$41.00

Hospital Charge Code	24100618
Hospital Revenue Code	270
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

KWIRE SMOOTH DOUBLE TORCAR .45INX9IN

Facility

IP

$41.00

Hospital Charge Code	24100618
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

KWIRE SMOOTH DOUBLE TROCAR 035INX9IN

Facility

IP

$41.00

Hospital Charge Code	24100620
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Cash Price	$32.80

KWIRE SMOOTH DOUBLE TROCAR 035INX9IN

Facility

OP

$41.00

Hospital Charge Code	24100620
Hospital Revenue Code	270
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Arizona Complete Health Allwell	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$27.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$6.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.56
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$28.70
Rate for Payer: Devoted Health Medicare	$7.38
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Southwest Service Administrators UFCW	$27.88
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: United Healthcare Commercial	$23.45
Rate for Payer: United Healthcare Medicare	$6.56
Rate for Payer: Veterans Affairs TRICARE	$6.49

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