Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33
Rate for Payer: NaphCare Correctional Healthcare	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39
Rate for Payer: NaphCare Correctional Healthcare	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39
Rate for Payer: NaphCare Correctional Healthcare	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27
Rate for Payer: NaphCare Correctional Healthcare	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27
Rate for Payer: NaphCare Correctional Healthcare	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33
Rate for Payer: NaphCare Correctional Healthcare	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04
Rate for Payer: NaphCare Correctional Healthcare	$8,637.04

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39
Rate for Payer: NaphCare Correctional Healthcare	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27
Rate for Payer: NaphCare Correctional Healthcare	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33
Rate for Payer: NaphCare Correctional Healthcare	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04
Rate for Payer: NaphCare Correctional Healthcare	$8,637.04

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility

IP

$27,528.42

Service Code	MSDRG 734
Min. Negotiated Rate	$27,528.42
Max. Negotiated Rate	$27,528.42
Rate for Payer: Seven Corners Travel Insurance	$27,528.42

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility

IP

$17,404.49

Service Code	MSDRG 735
Min. Negotiated Rate	$17,404.49
Max. Negotiated Rate	$17,404.49
Rate for Payer: Seven Corners Travel Insurance	$17,404.49

Pelvic exam under anesthesia

Facility

OP

$680.00

Service Code	CPT 57400
Hospital Charge Code	27291800
Hospital Revenue Code	360
Min. Negotiated Rate	$107.71
Max. Negotiated Rate	$5,008.71
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Arizona Complete Health Allwell	$108.80
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$462.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$108.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$108.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$340.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Humana of AZ Medicare	$108.80
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: Southwest Service Administrators UFCW	$462.40
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$108.80
Rate for Payer: Veterans Affairs TRICARE	$107.71

Pelvic exam under anesthesia

Facility

IP

$680.00

Service Code	CPT 57400
Hospital Charge Code	27291800
Hospital Revenue Code	360
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Cash Price	$544.00

Penicillin G 5,000,000 units inj REC [CQCH]

Facility

OP

$5.48

Service Code	HCPCS J2540
Hospital Charge Code	105935952
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna of AZ Commercial	$4.93
Rate for Payer: Arizona Complete Health Allwell	$0.88
Rate for Payer: Banner UC Health Medicare	$0.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$3.73
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.88
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cigna of AZ Commercial	$3.56
Rate for Payer: Devoted Health Medicare	$0.99
Rate for Payer: Humana of AZ Medicare	$0.88
Rate for Payer: Southwest Service Administrators UFCW	$3.73
Rate for Payer: TriWest Medicare	$0.88
Rate for Payer: United Healthcare Commercial	$3.13
Rate for Payer: United Healthcare Medicare	$0.88
Rate for Payer: Veterans Affairs TRICARE	$0.87

Penicillin G 5,000,000 units inj REC [CQCH]

Facility

IP

$5.48

Service Code	HCPCS J2540
Hospital Charge Code	105935952
Hospital Revenue Code	250
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna of AZ Commercial	$4.93
Rate for Payer: Cash Price	$4.38

penicillin G benzathine 1,200,000 units/2 mL Sus [CQCH]

Facility

IP

$80.05

Service Code	HCPCS J0561
Hospital Charge Code	105935877
Hospital Revenue Code	250
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$72.05
Rate for Payer: Aetna of AZ Commercial	$72.05
Rate for Payer: Cash Price	$64.04

penicillin G benzathine 1,200,000 units/2 mL Sus [CQCH]

Facility

OP

$80.05

Service Code	HCPCS J0561
Hospital Charge Code	105935877
Hospital Revenue Code	250
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$72.05
Rate for Payer: Aetna of AZ Commercial	$72.05
Rate for Payer: Arizona Complete Health Allwell	$12.81
Rate for Payer: Banner UC Health Medicare	$12.81
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$54.43
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$12.81
Rate for Payer: Care1st Health Plan Arizona Medicare	$12.81
Rate for Payer: Cash Price	$64.04
Rate for Payer: Cash Price	$64.04
Rate for Payer: Cigna of AZ Commercial	$52.03
Rate for Payer: Devoted Health Medicare	$14.41
Rate for Payer: Humana of AZ Medicare	$12.81
Rate for Payer: Seven Corners Travel Insurance	$47.26
Rate for Payer: Southwest Service Administrators UFCW	$54.43
Rate for Payer: TriWest Medicare	$12.81
Rate for Payer: United Healthcare Commercial	$45.79
Rate for Payer: United Healthcare Medicare	$12.81
Rate for Payer: Veterans Affairs TRICARE	$12.68

Penicillin g benzathine inj, 100,000 units

Facility

OP

$26.00

Service Code	HCPCS J0561
Hospital Charge Code	1413451
Hospital Revenue Code	521
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$47.26
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Seven Corners Travel Insurance	$47.26
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

Penicillin g benzathine inj, 100,000 units

Facility

IP

$26.00

Service Code	HCPCS J0561
Hospital Charge Code	1413451
Hospital Revenue Code	521
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Cash Price	$20.80

Penicillin VK 250 mg Tab [CQCH]

Facility

OP

$0.08

Service Code	NDC 57237004001
Hospital Charge Code	105936021
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.05
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.05
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

Penicillin VK 250 mg Tab [CQCH]

Facility

IP

$0.08

Service Code	NDC 57237004001
Hospital Charge Code	105936021
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Cash Price	$0.06

PENIS PROCEDURES WITH CC/MCC

Facility

IP

$30,075.76

Service Code	MSDRG 709
Min. Negotiated Rate	$30,075.76
Max. Negotiated Rate	$30,075.76
Rate for Payer: Seven Corners Travel Insurance	$30,075.76

PENIS PROCEDURES WITHOUT CC/MCC

Facility

IP

$18,110.28

Service Code	MSDRG 710
Min. Negotiated Rate	$18,110.28
Max. Negotiated Rate	$18,110.28
Rate for Payer: Seven Corners Travel Insurance	$18,110.28

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