Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$55,504.59

Service Code	APR-DRG 0013
Hospital Charge Code	APRDRG0013
Min. Negotiated Rate	$55,504.59
Max. Negotiated Rate	$55,504.59
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,504.59
Rate for Payer: Mercy Care Medicaid	$55,504.59
Rate for Payer: NaphCare Correctional Healthcare	$55,504.59

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$46,835.28

Service Code	APR-DRG 0011
Hospital Charge Code	APRDRG0014
Min. Negotiated Rate	$46,835.28
Max. Negotiated Rate	$46,835.28
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,835.28
Rate for Payer: Mercy Care Medicaid	$46,835.28
Rate for Payer: NaphCare Correctional Healthcare	$46,835.28

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$55,504.59

Service Code	APR-DRG 0013
Hospital Charge Code	APRDRG0014
Min. Negotiated Rate	$55,504.59
Max. Negotiated Rate	$55,504.59
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,504.59
Rate for Payer: Mercy Care Medicaid	$55,504.59
Rate for Payer: NaphCare Correctional Healthcare	$55,504.59

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$46,835.28

Service Code	APR-DRG 0012
Hospital Charge Code	APRDRG0014
Min. Negotiated Rate	$46,835.28
Max. Negotiated Rate	$46,835.28
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,835.28
Rate for Payer: Mercy Care Medicaid	$46,835.28
Rate for Payer: NaphCare Correctional Healthcare	$46,835.28

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$117,754.54

Service Code	APR-DRG 0014
Hospital Charge Code	APRDRG0014
Min. Negotiated Rate	$117,754.54
Max. Negotiated Rate	$117,754.54
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$117,754.54
Rate for Payer: Mercy Care Medicaid	$117,754.54
Rate for Payer: NaphCare Correctional Healthcare	$117,754.54

Liver Transplant And/Or Intestinal Transplant

Facility

IP

$46,835.28

Service Code	APR-DRG 0012
Hospital Charge Code	APRDRG0013
Min. Negotiated Rate	$46,835.28
Max. Negotiated Rate	$46,835.28
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$46,835.28
Rate for Payer: Mercy Care Medicaid	$46,835.28
Rate for Payer: NaphCare Correctional Healthcare	$46,835.28

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

IP

$133,254.38

Service Code	MSDRG 005
Min. Negotiated Rate	$133,254.38
Max. Negotiated Rate	$133,254.38
Rate for Payer: Seven Corners Travel Insurance	$133,254.38

LIVER TRANSPLANT WITHOUT MCC

Facility

IP

$59,929.24

Service Code	MSDRG 006
Min. Negotiated Rate	$59,929.24
Max. Negotiated Rate	$59,929.24
Rate for Payer: Seven Corners Travel Insurance	$59,929.24

LNCS ADULT ADHESIVE SPO2 SENSOR

Facility

IP

$53.00

Hospital Charge Code	24249671
Hospital Revenue Code	270
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Cash Price	$42.40

LNCS ADULT ADHESIVE SPO2 SENSOR

Facility

OP

$53.00

Hospital Charge Code	24249671
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Arizona Complete Health Allwell	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Southwest Service Administrators UFCW	$36.04
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: United Healthcare Commercial	$30.32
Rate for Payer: United Healthcare Medicare	$8.48
Rate for Payer: Veterans Affairs TRICARE	$8.40

LNCS E1 SINGLE PATIENT EAR SENSOR

Facility

IP

$122.00

Hospital Charge Code	27736622
Hospital Revenue Code	270
Min. Negotiated Rate	$109.80
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of AZ Commercial	$109.80
Rate for Payer: Cash Price	$97.60

LNCS E1 SINGLE PATIENT EAR SENSOR

Facility

OP

$122.00

Hospital Charge Code	27736622
Hospital Revenue Code	270
Min. Negotiated Rate	$19.32
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of AZ Commercial	$109.80
Rate for Payer: Arizona Complete Health Allwell	$19.52
Rate for Payer: Banner UC Health Medicare	$19.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$82.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.52
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cigna of AZ Commercial	$85.40
Rate for Payer: Devoted Health Medicare	$21.96
Rate for Payer: Humana of AZ Medicare	$19.52
Rate for Payer: Southwest Service Administrators UFCW	$82.96
Rate for Payer: TriWest Medicare	$19.52
Rate for Payer: United Healthcare Commercial	$69.78
Rate for Payer: United Healthcare Medicare	$19.52
Rate for Payer: Veterans Affairs TRICARE	$19.32

LOBAN 2 ANITIMICROBIAL INCISE DRAPE 23X17

Facility

OP

$27.70

Hospital Charge Code	28046991
Hospital Revenue Code	270
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$24.93
Rate for Payer: Aetna of AZ Commercial	$24.93
Rate for Payer: Arizona Complete Health Allwell	$4.43
Rate for Payer: Banner UC Health Medicare	$4.43
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$18.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.43
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.43
Rate for Payer: Cash Price	$22.16
Rate for Payer: Cigna of AZ Commercial	$19.39
Rate for Payer: Devoted Health Medicare	$4.99
Rate for Payer: Humana of AZ Medicare	$4.43
Rate for Payer: Southwest Service Administrators UFCW	$18.84
Rate for Payer: TriWest Medicare	$4.43
Rate for Payer: United Healthcare Commercial	$15.84
Rate for Payer: United Healthcare Medicare	$4.43
Rate for Payer: Veterans Affairs TRICARE	$4.39

LOBAN 2 ANITIMICROBIAL INCISE DRAPE 23X17

Facility

IP

$27.70

Hospital Charge Code	28046991
Hospital Revenue Code	270
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$24.93
Rate for Payer: Aetna of AZ Commercial	$24.93
Rate for Payer: Cash Price	$22.16

Local Burn Treatment, 1st Degree Charge

Facility

IP

$174.00

Service Code	CPT 16000
Hospital Charge Code	713735
Hospital Revenue Code	521
Min. Negotiated Rate	$156.60
Max. Negotiated Rate	$156.60
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Cash Price	$139.20

Local Burn Treatment, 1st Degree Charge

Facility

OP

$174.00

Service Code	CPT 16000
Hospital Charge Code	713735
Hospital Revenue Code	521
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$310.43
Rate for Payer: Aetna of AZ Commercial	$156.60
Rate for Payer: Arizona Complete Health Allwell	$27.84
Rate for Payer: Banner UC Health Medicare	$27.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$118.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$35.57
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.84
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cigna of AZ Commercial	$121.80
Rate for Payer: Devoted Health Medicare	$31.32
Rate for Payer: Humana of AZ Medicare	$27.84
Rate for Payer: Mercy Care Medicaid	$35.57
Rate for Payer: NaphCare Correctional Healthcare	$35.57
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$118.32
Rate for Payer: TriWest Medicare	$27.84
Rate for Payer: United Healthcare Commercial	$99.53
Rate for Payer: United Healthcare Medicare	$27.84
Rate for Payer: Veterans Affairs TRICARE	$27.56

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

IP

$23,313.84

Service Code	MSDRG 496
Min. Negotiated Rate	$23,313.84
Max. Negotiated Rate	$23,313.84
Rate for Payer: Seven Corners Travel Insurance	$23,313.84

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

IP

$46,859.07

Service Code	MSDRG 495
Min. Negotiated Rate	$46,859.07
Max. Negotiated Rate	$46,859.07
Rate for Payer: Seven Corners Travel Insurance	$46,859.07

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

IP

$15,666.02

Service Code	MSDRG 497
Min. Negotiated Rate	$15,666.02
Max. Negotiated Rate	$15,666.02
Rate for Payer: Seven Corners Travel Insurance	$15,666.02

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

IP

$38,989.56

Service Code	MSDRG 498
Min. Negotiated Rate	$38,989.56
Max. Negotiated Rate	$38,989.56
Rate for Payer: Seven Corners Travel Insurance	$38,989.56

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

IP

$26,039.58

Service Code	MSDRG 499
Min. Negotiated Rate	$26,039.58
Max. Negotiated Rate	$26,039.58
Rate for Payer: Seven Corners Travel Insurance	$26,039.58

LONE STAR STAYS 5MM

Facility

OP

$267.00

Hospital Charge Code	22354905
Hospital Revenue Code	270
Min. Negotiated Rate	$42.29
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Arizona Complete Health Allwell	$42.72
Rate for Payer: Banner UC Health Medicare	$42.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$181.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.72
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cigna of AZ Commercial	$186.90
Rate for Payer: Devoted Health Medicare	$48.06
Rate for Payer: Humana of AZ Medicare	$42.72
Rate for Payer: Southwest Service Administrators UFCW	$181.56
Rate for Payer: TriWest Medicare	$42.72
Rate for Payer: United Healthcare Commercial	$152.72
Rate for Payer: United Healthcare Medicare	$42.72
Rate for Payer: Veterans Affairs TRICARE	$42.29

LONE STAR STAYS 5MM

Facility

IP

$267.00

Hospital Charge Code	22354905
Hospital Revenue Code	270
Min. Negotiated Rate	$240.30
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Cash Price	$213.60

LONG DRILL 1.7MM LONG

Facility

OP

$1,775.00

Hospital Charge Code	29522627
Hospital Revenue Code	270
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Arizona Complete Health Allwell	$284.00
Rate for Payer: Banner UC Health Medicare	$284.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,207.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$284.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$284.00
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Cigna of AZ Commercial	$1,242.50
Rate for Payer: Devoted Health Medicare	$319.50
Rate for Payer: Humana of AZ Medicare	$284.00
Rate for Payer: Southwest Service Administrators UFCW	$1,207.00
Rate for Payer: TriWest Medicare	$284.00
Rate for Payer: United Healthcare Commercial	$1,015.30
Rate for Payer: United Healthcare Medicare	$284.00
Rate for Payer: Veterans Affairs TRICARE	$281.16

LONG DRILL 1.7MM LONG

Facility

IP

$1,775.00

Hospital Charge Code	29522627
Hospital Revenue Code	270
Min. Negotiated Rate	$1,597.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Cash Price	$1,420.00

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