Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Neonatal Bili

Facility

IP

$124.00

Service Code	CPT 82248
Hospital Charge Code	1019625
Hospital Revenue Code	306
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

Neonatal Bili

Facility

OP

$124.00

Service Code	CPT 82248
Hospital Charge Code	1019625
Hospital Revenue Code	306
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Seven Corners Travel Insurance	$7.28
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$18,202.03

Service Code	APR-DRG 6031
Hospital Charge Code	APRDRG6032
Min. Negotiated Rate	$18,202.03
Max. Negotiated Rate	$18,202.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,202.03
Rate for Payer: Mercy Care Medicaid	$18,202.03
Rate for Payer: NaphCare Correctional Healthcare	$18,202.03

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$52,950.79

Service Code	APR-DRG 6033
Hospital Charge Code	APRDRG6033
Min. Negotiated Rate	$52,950.79
Max. Negotiated Rate	$52,950.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,950.79
Rate for Payer: Mercy Care Medicaid	$52,950.79
Rate for Payer: NaphCare Correctional Healthcare	$52,950.79

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$34,533.43

Service Code	APR-DRG 6032
Hospital Charge Code	APRDRG6033
Min. Negotiated Rate	$34,533.43
Max. Negotiated Rate	$34,533.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,533.43
Rate for Payer: Mercy Care Medicaid	$34,533.43
Rate for Payer: NaphCare Correctional Healthcare	$34,533.43

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$52,950.79

Service Code	APR-DRG 6033
Hospital Charge Code	APRDRG6034
Min. Negotiated Rate	$52,950.79
Max. Negotiated Rate	$52,950.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,950.79
Rate for Payer: Mercy Care Medicaid	$52,950.79
Rate for Payer: NaphCare Correctional Healthcare	$52,950.79

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$109,833.63

Service Code	APR-DRG 6034
Hospital Charge Code	APRDRG6031
Min. Negotiated Rate	$109,833.63
Max. Negotiated Rate	$109,833.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$109,833.63
Rate for Payer: Mercy Care Medicaid	$109,833.63
Rate for Payer: NaphCare Correctional Healthcare	$109,833.63

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$52,950.79

Service Code	APR-DRG 6033
Hospital Charge Code	APRDRG6031
Min. Negotiated Rate	$52,950.79
Max. Negotiated Rate	$52,950.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,950.79
Rate for Payer: Mercy Care Medicaid	$52,950.79
Rate for Payer: NaphCare Correctional Healthcare	$52,950.79

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$34,533.43

Service Code	APR-DRG 6032
Hospital Charge Code	APRDRG6032
Min. Negotiated Rate	$34,533.43
Max. Negotiated Rate	$34,533.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,533.43
Rate for Payer: Mercy Care Medicaid	$34,533.43
Rate for Payer: NaphCare Correctional Healthcare	$34,533.43

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$34,533.43

Service Code	APR-DRG 6032
Hospital Charge Code	APRDRG6031
Min. Negotiated Rate	$34,533.43
Max. Negotiated Rate	$34,533.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,533.43
Rate for Payer: Mercy Care Medicaid	$34,533.43
Rate for Payer: NaphCare Correctional Healthcare	$34,533.43

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$52,950.79

Service Code	APR-DRG 6033
Hospital Charge Code	APRDRG6032
Min. Negotiated Rate	$52,950.79
Max. Negotiated Rate	$52,950.79
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52,950.79
Rate for Payer: Mercy Care Medicaid	$52,950.79
Rate for Payer: NaphCare Correctional Healthcare	$52,950.79

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$34,533.43

Service Code	APR-DRG 6032
Hospital Charge Code	APRDRG6034
Min. Negotiated Rate	$34,533.43
Max. Negotiated Rate	$34,533.43
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,533.43
Rate for Payer: Mercy Care Medicaid	$34,533.43
Rate for Payer: NaphCare Correctional Healthcare	$34,533.43

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$18,202.03

Service Code	APR-DRG 6031
Hospital Charge Code	APRDRG6034
Min. Negotiated Rate	$18,202.03
Max. Negotiated Rate	$18,202.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,202.03
Rate for Payer: Mercy Care Medicaid	$18,202.03
Rate for Payer: NaphCare Correctional Healthcare	$18,202.03

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$18,202.03

Service Code	APR-DRG 6031
Hospital Charge Code	APRDRG6033
Min. Negotiated Rate	$18,202.03
Max. Negotiated Rate	$18,202.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,202.03
Rate for Payer: Mercy Care Medicaid	$18,202.03
Rate for Payer: NaphCare Correctional Healthcare	$18,202.03

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$109,833.63

Service Code	APR-DRG 6034
Hospital Charge Code	APRDRG6032
Min. Negotiated Rate	$109,833.63
Max. Negotiated Rate	$109,833.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$109,833.63
Rate for Payer: Mercy Care Medicaid	$109,833.63
Rate for Payer: NaphCare Correctional Healthcare	$109,833.63

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$18,202.03

Service Code	APR-DRG 6031
Hospital Charge Code	APRDRG6031
Min. Negotiated Rate	$18,202.03
Max. Negotiated Rate	$18,202.03
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$18,202.03
Rate for Payer: Mercy Care Medicaid	$18,202.03
Rate for Payer: NaphCare Correctional Healthcare	$18,202.03

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$109,833.63

Service Code	APR-DRG 6034
Hospital Charge Code	APRDRG6033
Min. Negotiated Rate	$109,833.63
Max. Negotiated Rate	$109,833.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$109,833.63
Rate for Payer: Mercy Care Medicaid	$109,833.63
Rate for Payer: NaphCare Correctional Healthcare	$109,833.63

Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition

Facility

IP

$109,833.63

Service Code	APR-DRG 6034
Hospital Charge Code	APRDRG6034
Min. Negotiated Rate	$109,833.63
Max. Negotiated Rate	$109,833.63
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$109,833.63
Rate for Payer: Mercy Care Medicaid	$109,833.63
Rate for Payer: NaphCare Correctional Healthcare	$109,833.63

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$90,728.90

Service Code	APR-DRG 6024
Hospital Charge Code	APRDRG6024
Min. Negotiated Rate	$90,728.90
Max. Negotiated Rate	$90,728.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$90,728.90
Rate for Payer: Mercy Care Medicaid	$90,728.90
Rate for Payer: NaphCare Correctional Healthcare	$90,728.90

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$90,728.90

Service Code	APR-DRG 6024
Hospital Charge Code	APRDRG6023
Min. Negotiated Rate	$90,728.90
Max. Negotiated Rate	$90,728.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$90,728.90
Rate for Payer: Mercy Care Medicaid	$90,728.90
Rate for Payer: NaphCare Correctional Healthcare	$90,728.90

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$90,728.90

Service Code	APR-DRG 6024
Hospital Charge Code	APRDRG6021
Min. Negotiated Rate	$90,728.90
Max. Negotiated Rate	$90,728.90
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$90,728.90
Rate for Payer: Mercy Care Medicaid	$90,728.90
Rate for Payer: NaphCare Correctional Healthcare	$90,728.90

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$55,438.66

Service Code	APR-DRG 6022
Hospital Charge Code	APRDRG6022
Min. Negotiated Rate	$55,438.66
Max. Negotiated Rate	$55,438.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,438.66
Rate for Payer: Mercy Care Medicaid	$55,438.66
Rate for Payer: NaphCare Correctional Healthcare	$55,438.66

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$55,438.66

Service Code	APR-DRG 6022
Hospital Charge Code	APRDRG6023
Min. Negotiated Rate	$55,438.66
Max. Negotiated Rate	$55,438.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,438.66
Rate for Payer: Mercy Care Medicaid	$55,438.66
Rate for Payer: NaphCare Correctional Healthcare	$55,438.66

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$55,438.66

Service Code	APR-DRG 6022
Hospital Charge Code	APRDRG6021
Min. Negotiated Rate	$55,438.66
Max. Negotiated Rate	$55,438.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55,438.66
Rate for Payer: Mercy Care Medicaid	$55,438.66
Rate for Payer: NaphCare Correctional Healthcare	$55,438.66

Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly

Facility

IP

$19,312.35

Service Code	APR-DRG 6021
Hospital Charge Code	APRDRG6022
Min. Negotiated Rate	$19,312.35
Max. Negotiated Rate	$19,312.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$19,312.35
Rate for Payer: Mercy Care Medicaid	$19,312.35
Rate for Payer: NaphCare Correctional Healthcare	$19,312.35

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