Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$20,628.17

Service Code	APR-DRG 3613
Hospital Charge Code	APRDRG3611
Min. Negotiated Rate	$20,628.17
Max. Negotiated Rate	$20,628.17
Rate for Payer: AHCCCS Medicaid	$20,628.17
Rate for Payer: Allwell Medicaid	$20,628.17
Rate for Payer: AZCH Complete Medicaid	$20,628.17
Rate for Payer: Banner UC Health Medicaid	$20,628.17
Rate for Payer: Mercy Care Medicaid	$20,628.17

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$20,628.17

Service Code	APR-DRG 3613
Hospital Charge Code	APRDRG3613
Min. Negotiated Rate	$20,628.17
Max. Negotiated Rate	$20,628.17
Rate for Payer: AHCCCS Medicaid	$20,628.17
Rate for Payer: Allwell Medicaid	$20,628.17
Rate for Payer: AZCH Complete Medicaid	$20,628.17
Rate for Payer: Banner UC Health Medicaid	$20,628.17
Rate for Payer: Mercy Care Medicaid	$20,628.17

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$10,155.57

Service Code	APR-DRG 3611
Hospital Charge Code	APRDRG3611
Min. Negotiated Rate	$10,155.57
Max. Negotiated Rate	$10,155.57
Rate for Payer: AHCCCS Medicaid	$10,155.57
Rate for Payer: Allwell Medicaid	$10,155.57
Rate for Payer: AZCH Complete Medicaid	$10,155.57
Rate for Payer: Banner UC Health Medicaid	$10,155.57
Rate for Payer: Mercy Care Medicaid	$10,155.57

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$10,155.57

Service Code	APR-DRG 3611
Hospital Charge Code	APRDRG3614
Min. Negotiated Rate	$10,155.57
Max. Negotiated Rate	$10,155.57
Rate for Payer: AHCCCS Medicaid	$10,155.57
Rate for Payer: Allwell Medicaid	$10,155.57
Rate for Payer: AZCH Complete Medicaid	$10,155.57
Rate for Payer: Banner UC Health Medicaid	$10,155.57
Rate for Payer: Mercy Care Medicaid	$10,155.57

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$12,534.72

Service Code	APR-DRG 3612
Hospital Charge Code	APRDRG3612
Min. Negotiated Rate	$12,534.72
Max. Negotiated Rate	$12,534.72
Rate for Payer: AHCCCS Medicaid	$12,534.72
Rate for Payer: Allwell Medicaid	$12,534.72
Rate for Payer: AZCH Complete Medicaid	$12,534.72
Rate for Payer: Banner UC Health Medicaid	$12,534.72
Rate for Payer: Mercy Care Medicaid	$12,534.72

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$20,628.17

Service Code	APR-DRG 3613
Hospital Charge Code	APRDRG3612
Min. Negotiated Rate	$20,628.17
Max. Negotiated Rate	$20,628.17
Rate for Payer: AHCCCS Medicaid	$20,628.17
Rate for Payer: Allwell Medicaid	$20,628.17
Rate for Payer: AZCH Complete Medicaid	$20,628.17
Rate for Payer: Banner UC Health Medicaid	$20,628.17
Rate for Payer: Mercy Care Medicaid	$20,628.17

Skin Graft For Skin And Subcutaneous Tissue Diagnoses

Facility

IP

$10,155.57

Service Code	APR-DRG 3611
Hospital Charge Code	APRDRG3612
Min. Negotiated Rate	$10,155.57
Max. Negotiated Rate	$10,155.57
Rate for Payer: AHCCCS Medicaid	$10,155.57
Rate for Payer: Allwell Medicaid	$10,155.57
Rate for Payer: AZCH Complete Medicaid	$10,155.57
Rate for Payer: Banner UC Health Medicaid	$10,155.57
Rate for Payer: Mercy Care Medicaid	$10,155.57

Skin Ulcers

Facility

IP

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

IP

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

IP

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

IP

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

IP

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3802
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

IP

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

IP

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

IP

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

IP

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

IP

$7,217.41

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$7,217.41
Max. Negotiated Rate	$7,217.41
Rate for Payer: AHCCCS Medicaid	$7,217.41
Rate for Payer: Allwell Medicaid	$7,217.41
Rate for Payer: AZCH Complete Medicaid	$7,217.41
Rate for Payer: Banner UC Health Medicaid	$7,217.41
Rate for Payer: Mercy Care Medicaid	$7,217.41

Skin Ulcers

Facility

IP

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

IP

$4,726.73

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$4,726.73
Max. Negotiated Rate	$4,726.73
Rate for Payer: AHCCCS Medicaid	$4,726.73
Rate for Payer: Allwell Medicaid	$4,726.73
Rate for Payer: AZCH Complete Medicaid	$4,726.73
Rate for Payer: Banner UC Health Medicaid	$4,726.73
Rate for Payer: Mercy Care Medicaid	$4,726.73

Skin Ulcers

Facility

IP

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

IP

$3,886.46

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG3801
Min. Negotiated Rate	$3,886.46
Max. Negotiated Rate	$3,886.46
Rate for Payer: AHCCCS Medicaid	$3,886.46
Rate for Payer: Allwell Medicaid	$3,886.46
Rate for Payer: AZCH Complete Medicaid	$3,886.46
Rate for Payer: Banner UC Health Medicaid	$3,886.46
Rate for Payer: Mercy Care Medicaid	$3,886.46

Skin Ulcers

Facility

IP

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3804
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

Skin Ulcers

Facility

IP

$15,164.97

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG3803
Min. Negotiated Rate	$15,164.97
Max. Negotiated Rate	$15,164.97
Rate for Payer: AHCCCS Medicaid	$15,164.97
Rate for Payer: Allwell Medicaid	$15,164.97
Rate for Payer: AZCH Complete Medicaid	$15,164.97
Rate for Payer: Banner UC Health Medicaid	$15,164.97
Rate for Payer: Mercy Care Medicaid	$15,164.97

SLEEVE ALP CALF

Facility

OP

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Aetna of AZ Medicare	$27.44
Rate for Payer: Allwell Medicare	$15.68
Rate for Payer: Amerigroup Medicare	$15.68
Rate for Payer: APIPA Medicare/Medicaid	$36.60
Rate for Payer: AZCH Complete Medicare	$15.68
Rate for Payer: Banner UC Health Medicare	$15.68
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$66.64
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cigna of AZ Commercial	$68.60
Rate for Payer: Copperpoint Commercial	$24.25
Rate for Payer: Health Net of AZ Commercial	$58.80
Rate for Payer: Health Net of AZ Medicare	$27.44
Rate for Payer: Humana of AZ Medicare	$15.68
Rate for Payer: Self Pay Self Pay	$78.40
Rate for Payer: TriWest Medicare	$15.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$57.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.64

SLEEVE ALP CALF

Facility

IP

$98.00

Hospital Charge Code	22354965
Hospital Revenue Code	270
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna of AZ Commercial	$88.20
Rate for Payer: Bisbee Police All Plans	$25.48
Rate for Payer: Cash Price	$78.40
Rate for Payer: Self Pay Self Pay	$78.40

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