Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37
Rate for Payer: NaphCare Correctional Healthcare	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79
Rate for Payer: NaphCare Correctional Healthcare	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$6,929.83

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$6,929.83
Max. Negotiated Rate	$6,929.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,929.83
Rate for Payer: Mercy Care Medicaid	$6,929.83
Rate for Payer: NaphCare Correctional Healthcare	$6,929.83

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37
Rate for Payer: NaphCare Correctional Healthcare	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79
Rate for Payer: NaphCare Correctional Healthcare	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$29,766.71

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$29,766.71
Max. Negotiated Rate	$29,766.71
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,766.71
Rate for Payer: Mercy Care Medicaid	$29,766.71
Rate for Payer: NaphCare Correctional Healthcare	$29,766.71

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$6,929.83

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG9512
Min. Negotiated Rate	$6,929.83
Max. Negotiated Rate	$6,929.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,929.83
Rate for Payer: Mercy Care Medicaid	$6,929.83
Rate for Payer: NaphCare Correctional Healthcare	$6,929.83

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9512
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79
Rate for Payer: NaphCare Correctional Healthcare	$10,065.79

Moderna Spikevax COVID 196 months to 11 years

Facility

IP

$147.06

Service Code	CPT 91321
Hospital Charge Code	28132207
Hospital Revenue Code	521
Min. Negotiated Rate	$132.35
Max. Negotiated Rate	$132.35
Rate for Payer: Aetna of AZ Commercial	$132.35
Rate for Payer: Cash Price	$117.65

Moderna Spikevax COVID 196 months to 11 years

Facility

OP

$147.06

Service Code	CPT 91321
Hospital Charge Code	28132207
Hospital Revenue Code	521
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$132.35
Rate for Payer: Aetna of AZ Commercial	$132.35
Rate for Payer: Arizona Complete Health Allwell	$23.53
Rate for Payer: Banner UC Health Medicare	$23.53
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$100.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.53
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.53
Rate for Payer: Cash Price	$117.65
Rate for Payer: Cigna of AZ Commercial	$102.94
Rate for Payer: Devoted Health Medicare	$26.47
Rate for Payer: Humana of AZ Medicare	$23.53
Rate for Payer: Southwest Service Administrators UFCW	$100.00
Rate for Payer: TriWest Medicare	$23.53
Rate for Payer: United Healthcare Commercial	$84.12
Rate for Payer: United Healthcare Medicare	$23.53
Rate for Payer: Veterans Affairs TRICARE	$23.29

Moderna Third dose

Facility

OP

$55.00

Service Code	CPT 0013A
Hospital Charge Code	24381662
Hospital Revenue Code	521
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

Moderna Third dose

Facility

IP

$55.00

Service Code	CPT 0013A
Hospital Charge Code	24381662
Hospital Revenue Code	521
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

.MOLECULAR CYTOGEN DNA PROBE FISH

Facility

OP

$195.00

Service Code	CPT 88271
Hospital Charge Code	22481448
Hospital Revenue Code	310
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Arizona Complete Health Allwell	$31.20
Rate for Payer: Banner UC Health Medicare	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$132.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Devoted Health Medicare	$35.10
Rate for Payer: Humana of AZ Medicare	$31.20
Rate for Payer: Seven Corners Travel Insurance	$31.06
Rate for Payer: Southwest Service Administrators UFCW	$132.60
Rate for Payer: TriWest Medicare	$31.20
Rate for Payer: United Healthcare Commercial	$111.54
Rate for Payer: United Healthcare Medicare	$31.20
Rate for Payer: Veterans Affairs TRICARE	$30.89

.MOLECULAR CYTOGEN DNA PROBE FISH

Facility

IP

$195.00

Service Code	CPT 88271
Hospital Charge Code	22481448
Hospital Revenue Code	310
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Cash Price	$156.00

Mononucleosis Screen

Facility

OP

$129.00

Service Code	CPT 86308
Hospital Charge Code	633785
Hospital Revenue Code	302
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Arizona Complete Health Allwell	$20.64
Rate for Payer: Banner UC Health Medicare	$20.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$87.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$20.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$20.64
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cigna of AZ Commercial	$83.85
Rate for Payer: Devoted Health Medicare	$23.22
Rate for Payer: Humana of AZ Medicare	$20.64
Rate for Payer: Seven Corners Travel Insurance	$7.51
Rate for Payer: Southwest Service Administrators UFCW	$87.72
Rate for Payer: TriWest Medicare	$20.64
Rate for Payer: United Healthcare Commercial	$73.79
Rate for Payer: United Healthcare Medicare	$20.64
Rate for Payer: Veterans Affairs TRICARE	$20.43

Mononucleosis Screen

Facility

IP

$129.00

Service Code	CPT 86308
Hospital Charge Code	633785
Hospital Revenue Code	302
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Aetna of AZ Commercial	$116.10
Rate for Payer: Cash Price	$103.20

Monsel's (ferric subsulfate) topical Soln [CQCH]

Facility

OP

$1.84

Service Code	NDC 48783011208
Hospital Charge Code	114598869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Arizona Complete Health Allwell	$0.29
Rate for Payer: Banner UC Health Medicare	$0.29
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.29
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.29
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.20
Rate for Payer: Devoted Health Medicare	$0.33
Rate for Payer: Humana of AZ Medicare	$0.29
Rate for Payer: Southwest Service Administrators UFCW	$1.25
Rate for Payer: TriWest Medicare	$0.29
Rate for Payer: United Healthcare Commercial	$1.05
Rate for Payer: United Healthcare Medicare	$0.29
Rate for Payer: Veterans Affairs TRICARE	$0.29

Monsel's (ferric subsulfate) topical Soln [CQCH]

Facility

IP

$1.84

Service Code	NDC 48783011208
Hospital Charge Code	114598869
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Cash Price	$1.47

montelukast 10 mg Tab [CQCH]

Facility

IP

$2.49

Service Code	NDC 50268057515
Hospital Charge Code	105932568
Hospital Revenue Code	251
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Aetna of AZ Commercial	$2.24
Rate for Payer: Cash Price	$1.99

montelukast 10 mg Tab [CQCH]

Facility

OP

$2.49

Service Code	NDC 50268057515
Hospital Charge Code	105932568
Hospital Revenue Code	251
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$2.24
Rate for Payer: Aetna of AZ Commercial	$2.24
Rate for Payer: Arizona Complete Health Allwell	$0.40
Rate for Payer: Banner UC Health Medicare	$0.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.69
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.40
Rate for Payer: Cash Price	$1.99
Rate for Payer: Cigna of AZ Commercial	$1.62
Rate for Payer: Devoted Health Medicare	$0.45
Rate for Payer: Humana of AZ Medicare	$0.40
Rate for Payer: Southwest Service Administrators UFCW	$1.69
Rate for Payer: TriWest Medicare	$0.40
Rate for Payer: United Healthcare Commercial	$1.42
Rate for Payer: United Healthcare Medicare	$0.40
Rate for Payer: Veterans Affairs TRICARE	$0.39

MORGAN LENSE

Facility

OP

$118.00

Hospital Charge Code	22354271
Hospital Revenue Code	270
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Arizona Complete Health Allwell	$18.88
Rate for Payer: Banner UC Health Medicare	$18.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$80.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.88
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$82.60
Rate for Payer: Devoted Health Medicare	$21.24
Rate for Payer: Humana of AZ Medicare	$18.88
Rate for Payer: Southwest Service Administrators UFCW	$80.24
Rate for Payer: TriWest Medicare	$18.88
Rate for Payer: United Healthcare Commercial	$67.50
Rate for Payer: United Healthcare Medicare	$18.88
Rate for Payer: Veterans Affairs TRICARE	$18.69

MORGAN LENSE

Facility

IP

$118.00

Hospital Charge Code	22354271
Hospital Revenue Code	270
Min. Negotiated Rate	$106.20
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Cash Price	$94.40

morphine 10 mg/5 mL Oral Sol UD [CQCH]

Facility

OP

$0.24

Service Code	NDC 66689003250
Hospital Charge Code	105964301
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.16
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.14
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

morphine 10 mg/5 mL Oral Sol UD [CQCH]

Facility

IP

$0.24

Service Code	NDC 66689003250
Hospital Charge Code	105964301
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Cash Price	$0.19

morphine 10 mg/mL preservative-free Sol[CQCH]

Facility

OP

$1.94

Service Code	HCPCS J2274
Hospital Charge Code	169360742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna of AZ Commercial	$1.75
Rate for Payer: Arizona Complete Health Allwell	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.31
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.31
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of AZ Commercial	$1.26
Rate for Payer: Devoted Health Medicare	$0.35
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Southwest Service Administrators UFCW	$1.32
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: United Healthcare Commercial	$1.11
Rate for Payer: United Healthcare Medicare	$0.31
Rate for Payer: Veterans Affairs TRICARE	$0.31

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