Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2221
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01
Rate for Payer: NaphCare Correctional Healthcare	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$5,064.81

Service Code	APR-DRG 2221
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$5,064.81
Max. Negotiated Rate	$5,064.81
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,064.81
Rate for Payer: Mercy Care Medicaid	$5,064.81
Rate for Payer: NaphCare Correctional Healthcare	$5,064.81

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94
Rate for Payer: NaphCare Correctional Healthcare	$27,475.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01
Rate for Payer: NaphCare Correctional Healthcare	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$8,136.94

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG2224
Min. Negotiated Rate	$8,136.94
Max. Negotiated Rate	$8,136.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,136.94
Rate for Payer: Mercy Care Medicaid	$8,136.94
Rate for Payer: NaphCare Correctional Healthcare	$8,136.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$8,136.94

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG2222
Min. Negotiated Rate	$8,136.94
Max. Negotiated Rate	$8,136.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,136.94
Rate for Payer: Mercy Care Medicaid	$8,136.94
Rate for Payer: NaphCare Correctional Healthcare	$8,136.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2221
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94
Rate for Payer: NaphCare Correctional Healthcare	$27,475.94

OTHER VASCULAR PROCEDURES WITH CC

Facility

IP

$33,545.88

Service Code	MSDRG 253
Min. Negotiated Rate	$33,545.88
Max. Negotiated Rate	$33,545.88
Rate for Payer: Seven Corners Travel Insurance	$33,545.88

OTHER VASCULAR PROCEDURES WITH MCC

Facility

IP

$45,083.28

Service Code	MSDRG 252
Min. Negotiated Rate	$45,083.28
Max. Negotiated Rate	$45,083.28
Rate for Payer: Seven Corners Travel Insurance	$45,083.28

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

IP

$23,026.93

Service Code	MSDRG 254
Min. Negotiated Rate	$23,026.93
Max. Negotiated Rate	$23,026.93
Rate for Payer: Seven Corners Travel Insurance	$23,026.93

OT IONTOPHORESIS @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97033 GO
Hospital Charge Code	691323
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

OT IONTOPHORESIS @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97033 GO
Hospital Charge Code	691323
Hospital Revenue Code	430
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.83
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

OTITIS MEDIA AND URI WITH MCC

Facility

IP

$15,335.32

Service Code	MSDRG 152
Min. Negotiated Rate	$15,335.32
Max. Negotiated Rate	$15,335.32
Rate for Payer: Seven Corners Travel Insurance	$15,335.32

OTITIS MEDIA AND URI WITHOUT MCC

Facility

IP

$9,709.30

Service Code	MSDRG 153
Min. Negotiated Rate	$9,709.30
Max. Negotiated Rate	$9,709.30
Rate for Payer: Seven Corners Travel Insurance	$9,709.30

OT MAN THER TECH @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97140 GO
Hospital Charge Code	691319
Hospital Revenue Code	430
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.03
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

OT MAN THER TECH @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97140 GO
Hospital Charge Code	691319
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

OT MASSAGE EA 15 MIN

Facility

IP

$181.00

Service Code	CPT 97124 GO
Hospital Charge Code	691318
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

OT MASSAGE EA 15 MIN

Facility

OP

$181.00

Service Code	CPT 97124 GO
Hospital Charge Code	691318
Hospital Revenue Code	430
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$30.81
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

OT NEURO RE-ED @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97112 GO
Hospital Charge Code	691316
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

OT NEURO RE-ED @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97112 GO
Hospital Charge Code	691316
Hospital Revenue Code	430
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.99
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

OT ORTHO FITTING/TRAINING @ 15 E

Facility

OP

$172.00

Service Code	CPT 97760 GO
Hospital Charge Code	1341990
Hospital Revenue Code	430
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.80
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: United Healthcare New Mexico Commercial	$32.68
Rate for Payer: Veterans Affairs TRICARE	$27.24

OT ORTHO FITTING/TRAINING @ 15 E

Facility

IP

$172.00

Service Code	CPT 97760 GO
Hospital Charge Code	1341990
Hospital Revenue Code	430
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

OT PARAFFIN BATH

Facility

OP

$181.00

Service Code	CPT 97018
Hospital Charge Code	1230341
Hospital Revenue Code	430
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$6.37
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: United Healthcare New Mexico Commercial	$34.39
Rate for Payer: Veterans Affairs TRICARE	$28.67

OT PARAFFIN BATH

Facility

IP

$181.00

Service Code	CPT 97018
Hospital Charge Code	1230341
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

OT PROSTH TRAIN EA 15 MIN

Facility

IP

$181.00

Service Code	CPT 97761 GO
Hospital Charge Code	1238651
Hospital Revenue Code	430
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

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