Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Amputation Of Lower Limb Except Toes

Facility

IP

$9,240.95

Service Code	APR-DRG 3052
Hospital Charge Code	APRDRG3054
Min. Negotiated Rate	$9,240.95
Max. Negotiated Rate	$9,240.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,240.95
Rate for Payer: Mercy Care Medicaid	$9,240.95
Rate for Payer: NaphCare Correctional Healthcare	$9,240.95

Amputation Of Lower Limb Except Toes

Facility

IP

$29,803.89

Service Code	APR-DRG 3054
Hospital Charge Code	APRDRG3053
Min. Negotiated Rate	$29,803.89
Max. Negotiated Rate	$29,803.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,803.89
Rate for Payer: Mercy Care Medicaid	$29,803.89
Rate for Payer: NaphCare Correctional Healthcare	$29,803.89

Amputation Of Lower Limb Except Toes

Facility

IP

$29,803.89

Service Code	APR-DRG 3054
Hospital Charge Code	APRDRG3054
Min. Negotiated Rate	$29,803.89
Max. Negotiated Rate	$29,803.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,803.89
Rate for Payer: Mercy Care Medicaid	$29,803.89
Rate for Payer: NaphCare Correctional Healthcare	$29,803.89

Amputation Of Lower Limb Except Toes

Facility

IP

$14,950.34

Service Code	APR-DRG 3053
Hospital Charge Code	APRDRG3051
Min. Negotiated Rate	$14,950.34
Max. Negotiated Rate	$14,950.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,950.34
Rate for Payer: Mercy Care Medicaid	$14,950.34
Rate for Payer: NaphCare Correctional Healthcare	$14,950.34

Amputation Of Lower Limb Except Toes

Facility

IP

$9,240.95

Service Code	APR-DRG 3052
Hospital Charge Code	APRDRG3052
Min. Negotiated Rate	$9,240.95
Max. Negotiated Rate	$9,240.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,240.95
Rate for Payer: Mercy Care Medicaid	$9,240.95
Rate for Payer: NaphCare Correctional Healthcare	$9,240.95

Amputation Of Lower Limb Except Toes

Facility

IP

$9,240.95

Service Code	APR-DRG 3052
Hospital Charge Code	APRDRG3051
Min. Negotiated Rate	$9,240.95
Max. Negotiated Rate	$9,240.95
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,240.95
Rate for Payer: Mercy Care Medicaid	$9,240.95
Rate for Payer: NaphCare Correctional Healthcare	$9,240.95

Amputation Of Lower Limb Except Toes

Facility

IP

$29,803.89

Service Code	APR-DRG 3054
Hospital Charge Code	APRDRG3052
Min. Negotiated Rate	$29,803.89
Max. Negotiated Rate	$29,803.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,803.89
Rate for Payer: Mercy Care Medicaid	$29,803.89
Rate for Payer: NaphCare Correctional Healthcare	$29,803.89

Amputation Of Lower Limb Except Toes

Facility

IP

$14,950.34

Service Code	APR-DRG 3053
Hospital Charge Code	APRDRG3054
Min. Negotiated Rate	$14,950.34
Max. Negotiated Rate	$14,950.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,950.34
Rate for Payer: Mercy Care Medicaid	$14,950.34
Rate for Payer: NaphCare Correctional Healthcare	$14,950.34

Amputation Of Lower Limb Except Toes

Facility

IP

$6,739.05

Service Code	APR-DRG 3051
Hospital Charge Code	APRDRG3051
Min. Negotiated Rate	$6,739.05
Max. Negotiated Rate	$6,739.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,739.05
Rate for Payer: Mercy Care Medicaid	$6,739.05
Rate for Payer: NaphCare Correctional Healthcare	$6,739.05

Amputation Of Lower Limb Except Toes

Facility

IP

$6,739.05

Service Code	APR-DRG 3051
Hospital Charge Code	APRDRG3054
Min. Negotiated Rate	$6,739.05
Max. Negotiated Rate	$6,739.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,739.05
Rate for Payer: Mercy Care Medicaid	$6,739.05
Rate for Payer: NaphCare Correctional Healthcare	$6,739.05

Amputation Of Lower Limb Except Toes

Facility

IP

$6,739.05

Service Code	APR-DRG 3051
Hospital Charge Code	APRDRG3053
Min. Negotiated Rate	$6,739.05
Max. Negotiated Rate	$6,739.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,739.05
Rate for Payer: Mercy Care Medicaid	$6,739.05
Rate for Payer: NaphCare Correctional Healthcare	$6,739.05

Amputation Of Lower Limb Except Toes

Facility

IP

$29,803.89

Service Code	APR-DRG 3054
Hospital Charge Code	APRDRG3051
Min. Negotiated Rate	$29,803.89
Max. Negotiated Rate	$29,803.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$29,803.89
Rate for Payer: Mercy Care Medicaid	$29,803.89
Rate for Payer: NaphCare Correctional Healthcare	$29,803.89

Amputation Of Lower Limb Except Toes

Facility

IP

$14,950.34

Service Code	APR-DRG 3053
Hospital Charge Code	APRDRG3053
Min. Negotiated Rate	$14,950.34
Max. Negotiated Rate	$14,950.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,950.34
Rate for Payer: Mercy Care Medicaid	$14,950.34
Rate for Payer: NaphCare Correctional Healthcare	$14,950.34

Amputation Of Lower Limb Except Toes

Facility

IP

$6,739.05

Service Code	APR-DRG 3051
Hospital Charge Code	APRDRG3052
Min. Negotiated Rate	$6,739.05
Max. Negotiated Rate	$6,739.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,739.05
Rate for Payer: Mercy Care Medicaid	$6,739.05
Rate for Payer: NaphCare Correctional Healthcare	$6,739.05

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

IP

$24,172.02

Service Code	MSDRG 617
Min. Negotiated Rate	$24,172.02
Max. Negotiated Rate	$24,172.02
Rate for Payer: Seven Corners Travel Insurance	$24,172.02

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

IP

$45,071.63

Service Code	MSDRG 616
Min. Negotiated Rate	$45,071.63
Max. Negotiated Rate	$45,071.63
Rate for Payer: Seven Corners Travel Insurance	$45,071.63

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

IP

$18,330.31

Service Code	MSDRG 618
Min. Negotiated Rate	$18,330.31
Max. Negotiated Rate	$18,330.31
Rate for Payer: Seven Corners Travel Insurance	$18,330.31

AMPUTATION, TOE; METATARSOPHALANGEAL JOINT

Facility

OP

$5,062.66

Service Code	CPT 28820
Hospital Revenue Code	360
Min. Negotiated Rate	$118.55
Max. Negotiated Rate	$5,062.66
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$118.55
Rate for Payer: Mercy Care Medicaid	$118.55
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: United Healthcare Commercial	$4,169.00

AMS 65ML RESERVOIR

Facility

IP

$6,130.00

Hospital Charge Code	22354149
Hospital Revenue Code	270
Min. Negotiated Rate	$5,517.00
Max. Negotiated Rate	$5,517.00
Rate for Payer: Aetna of AZ Commercial	$5,517.00
Rate for Payer: Cash Price	$4,904.00

AMS 65ML RESERVOIR

Facility

OP

$6,130.00

Hospital Charge Code	22354149
Hospital Revenue Code	270
Min. Negotiated Rate	$970.99
Max. Negotiated Rate	$5,517.00
Rate for Payer: Aetna of AZ Commercial	$5,517.00
Rate for Payer: Arizona Complete Health Allwell	$980.80
Rate for Payer: Banner UC Health Medicare	$980.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$4,168.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$980.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$980.80
Rate for Payer: Cash Price	$4,904.00
Rate for Payer: Cigna of AZ Commercial	$4,291.00
Rate for Payer: Devoted Health Medicare	$1,103.40
Rate for Payer: Humana of AZ Medicare	$980.80
Rate for Payer: Southwest Service Administrators UFCW	$4,168.40
Rate for Payer: TriWest Medicare	$980.80
Rate for Payer: United Healthcare Commercial	$3,506.36
Rate for Payer: United Healthcare Medicare	$980.80
Rate for Payer: Veterans Affairs TRICARE	$970.99

AMS 700 ACCESSORY KIT

Facility

OP

$1,985.00

Hospital Charge Code	22354145
Hospital Revenue Code	270
Min. Negotiated Rate	$314.42
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Arizona Complete Health Allwell	$317.60
Rate for Payer: Banner UC Health Medicare	$317.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,349.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$317.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$317.60
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$1,389.50
Rate for Payer: Devoted Health Medicare	$357.30
Rate for Payer: Humana of AZ Medicare	$317.60
Rate for Payer: Southwest Service Administrators UFCW	$1,349.80
Rate for Payer: TriWest Medicare	$317.60
Rate for Payer: United Healthcare Commercial	$1,135.42
Rate for Payer: United Healthcare Medicare	$317.60
Rate for Payer: Veterans Affairs TRICARE	$314.42

AMS 700 ACCESSORY KIT

Facility

IP

$1,985.00

Hospital Charge Code	22354145
Hospital Revenue Code	270
Min. Negotiated Rate	$1,786.50
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Cash Price	$1,588.00

AMS 700 CX MS PUMP 18CM CYLINDERS

Facility

IP

$24,031.00

Hospital Charge Code	22354150
Hospital Revenue Code	270
Min. Negotiated Rate	$21,627.90
Max. Negotiated Rate	$21,627.90
Rate for Payer: Aetna of AZ Commercial	$21,627.90
Rate for Payer: Cash Price	$19,224.80

AMS 700 CX MS PUMP 18CM CYLINDERS

Facility

OP

$24,031.00

Hospital Charge Code	22354150
Hospital Revenue Code	270
Min. Negotiated Rate	$3,806.51
Max. Negotiated Rate	$21,627.90
Rate for Payer: Aetna of AZ Commercial	$21,627.90
Rate for Payer: Arizona Complete Health Allwell	$3,844.96
Rate for Payer: Banner UC Health Medicare	$3,844.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$16,341.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,844.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,844.96
Rate for Payer: Cash Price	$19,224.80
Rate for Payer: Cigna of AZ Commercial	$16,821.70
Rate for Payer: Devoted Health Medicare	$4,325.58
Rate for Payer: Humana of AZ Medicare	$3,844.96
Rate for Payer: Southwest Service Administrators UFCW	$16,341.08
Rate for Payer: TriWest Medicare	$3,844.96
Rate for Payer: United Healthcare Commercial	$13,745.73
Rate for Payer: United Healthcare Medicare	$3,844.96
Rate for Payer: Veterans Affairs TRICARE	$3,806.51

AMS SKW RETRACTION KIT

Facility

OP

$1,111.00

Hospital Charge Code	22354148
Hospital Revenue Code	270
Min. Negotiated Rate	$175.98
Max. Negotiated Rate	$999.90
Rate for Payer: Aetna of AZ Commercial	$999.90
Rate for Payer: Arizona Complete Health Allwell	$177.76
Rate for Payer: Banner UC Health Medicare	$177.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$755.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$177.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$177.76
Rate for Payer: Cash Price	$888.80
Rate for Payer: Cigna of AZ Commercial	$777.70
Rate for Payer: Devoted Health Medicare	$199.98
Rate for Payer: Humana of AZ Medicare	$177.76
Rate for Payer: Southwest Service Administrators UFCW	$755.48
Rate for Payer: TriWest Medicare	$177.76
Rate for Payer: United Healthcare Commercial	$635.49
Rate for Payer: United Healthcare Medicare	$177.76
Rate for Payer: Veterans Affairs TRICARE	$175.98

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