Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$4,350.78

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG0571
Min. Negotiated Rate	$4,350.78
Max. Negotiated Rate	$4,350.78
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,350.78
Rate for Payer: Mercy Care Medicaid	$4,350.78
Rate for Payer: NaphCare Correctional Healthcare	$4,350.78

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0573
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19
Rate for Payer: NaphCare Correctional Healthcare	$6,008.19

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0574
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19
Rate for Payer: NaphCare Correctional Healthcare	$6,008.19

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$8,392.25

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$8,392.25
Max. Negotiated Rate	$8,392.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,392.25
Rate for Payer: Mercy Care Medicaid	$8,392.25
Rate for Payer: NaphCare Correctional Healthcare	$8,392.25

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19
Rate for Payer: NaphCare Correctional Healthcare	$6,008.19

CONCUSSION WITH CC

Facility

IP

$14,276.02

Service Code	MSDRG 089
Min. Negotiated Rate	$14,276.02
Max. Negotiated Rate	$14,276.02
Rate for Payer: Seven Corners Travel Insurance	$14,276.02

CONCUSSION WITH MCC

Facility

IP

$17,484.33

Service Code	MSDRG 088
Min. Negotiated Rate	$17,484.33
Max. Negotiated Rate	$17,484.33
Rate for Payer: Seven Corners Travel Insurance	$17,484.33

CONCUSSION WITHOUT CC/MCC

Facility

IP

$10,786.35

Service Code	MSDRG 090
Min. Negotiated Rate	$10,786.35
Max. Negotiated Rate	$10,786.35
Rate for Payer: Seven Corners Travel Insurance	$10,786.35

CONE TIP URETERAL CATHETER 6FR

Facility

IP

$67.00

Hospital Charge Code	27748907
Hospital Revenue Code	270
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Cash Price	$53.60

CONE TIP URETERAL CATHETER 6FR

Facility

OP

$67.00

Hospital Charge Code	27748907
Hospital Revenue Code	270
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Arizona Complete Health Allwell	$10.72
Rate for Payer: Banner UC Health Medicare	$10.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$45.56
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.72
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.72
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Devoted Health Medicare	$12.06
Rate for Payer: Humana of AZ Medicare	$10.72
Rate for Payer: Southwest Service Administrators UFCW	$45.56
Rate for Payer: TriWest Medicare	$10.72
Rate for Payer: United Healthcare Commercial	$38.32
Rate for Payer: United Healthcare Medicare	$10.72
Rate for Payer: Veterans Affairs TRICARE	$10.61

Confirmation Tests THC

Facility

IP

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090933
Hospital Revenue Code	301
Min. Negotiated Rate	$253.80
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Cash Price	$225.60

Confirmation Tests THC

Facility

OP

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090933
Hospital Revenue Code	301
Min. Negotiated Rate	$44.67
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Arizona Complete Health Allwell	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$191.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.12
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Devoted Health Medicare	$50.76
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Seven Corners Travel Insurance	$90.10
Rate for Payer: Southwest Service Administrators UFCW	$191.76
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: United Healthcare Commercial	$161.30
Rate for Payer: United Healthcare Medicare	$45.12
Rate for Payer: Veterans Affairs TRICARE	$44.67

Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser

Facility

OP

$5,008.71

Service Code	CPT 57520
Hospital Revenue Code	360
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$5,008.71
Rate for Payer: Banner UC Health Medicare	$1,051.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$55.44
Rate for Payer: Mercy Care Medicaid	$55.44
Rate for Payer: NaphCare Correctional Healthcare	$1,051.19
Rate for Payer: Seven Corners Travel Insurance	$5,008.71
Rate for Payer: United Healthcare Commercial	$4,169.00

conjugated estrogens 0.625 mg/g Vag Crm w/Appl [CQCH]

Facility

OP

$330.90

Service Code	NDC 46087221
Hospital Charge Code	105917457
Hospital Revenue Code	251
Min. Negotiated Rate	$52.41
Max. Negotiated Rate	$297.81
Rate for Payer: Aetna of AZ Commercial	$297.81
Rate for Payer: Arizona Complete Health Allwell	$52.94
Rate for Payer: Banner UC Health Medicare	$52.94
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$225.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.94
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.94
Rate for Payer: Cash Price	$264.72
Rate for Payer: Cigna of AZ Commercial	$215.09
Rate for Payer: Devoted Health Medicare	$59.56
Rate for Payer: Humana of AZ Medicare	$52.94
Rate for Payer: Southwest Service Administrators UFCW	$225.01
Rate for Payer: TriWest Medicare	$52.94
Rate for Payer: United Healthcare Commercial	$189.27
Rate for Payer: United Healthcare Medicare	$52.94
Rate for Payer: Veterans Affairs TRICARE	$52.41

conjugated estrogens 0.625 mg/g Vag Crm w/Appl [CQCH]

Facility

IP

$330.90

Service Code	NDC 46087221
Hospital Charge Code	105917457
Hospital Revenue Code	251
Min. Negotiated Rate	$297.81
Max. Negotiated Rate	$297.81
Rate for Payer: Aetna of AZ Commercial	$297.81
Rate for Payer: Cash Price	$264.72

conjugated estrogens 0.625 mg Tab [CQCH]

Facility

OP

$3.00

Service Code	NDC 46110281
Hospital Charge Code	105917392
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Arizona Complete Health Allwell	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.48
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cigna of AZ Commercial	$1.95
Rate for Payer: Devoted Health Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Southwest Service Administrators UFCW	$2.04
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: United Healthcare Commercial	$1.72
Rate for Payer: United Healthcare Medicare	$0.48
Rate for Payer: Veterans Affairs TRICARE	$0.48

conjugated estrogens 0.625 mg Tab [CQCH]

Facility

IP

$3.00

Service Code	NDC 46110281
Hospital Charge Code	105917392
Hospital Revenue Code	251
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Cash Price	$2.40

CONNECTING TUBING FOR CUFF PRESSURE GAUGE

Facility

IP

$57.57

Hospital Charge Code	28000331
Hospital Revenue Code	270
Min. Negotiated Rate	$51.81
Max. Negotiated Rate	$51.81
Rate for Payer: Aetna of AZ Commercial	$51.81
Rate for Payer: Cash Price	$46.06

CONNECTING TUBING FOR CUFF PRESSURE GAUGE

Facility

OP

$57.57

Hospital Charge Code	28000331
Hospital Revenue Code	270
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$51.81
Rate for Payer: Aetna of AZ Commercial	$51.81
Rate for Payer: Arizona Complete Health Allwell	$9.21
Rate for Payer: Banner UC Health Medicare	$9.21
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.21
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.21
Rate for Payer: Cash Price	$46.06
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Devoted Health Medicare	$10.36
Rate for Payer: Humana of AZ Medicare	$9.21
Rate for Payer: Southwest Service Administrators UFCW	$39.15
Rate for Payer: TriWest Medicare	$9.21
Rate for Payer: United Healthcare Commercial	$32.93
Rate for Payer: United Healthcare Medicare	$9.21
Rate for Payer: Veterans Affairs TRICARE	$9.12

Connective Tissue Disorders

Facility

IP

$4,388.66

Service Code	APR-DRG 3461
Hospital Charge Code	APRDRG3462
Min. Negotiated Rate	$4,388.66
Max. Negotiated Rate	$4,388.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,388.66
Rate for Payer: Mercy Care Medicaid	$4,388.66
Rate for Payer: NaphCare Correctional Healthcare	$4,388.66

Connective Tissue Disorders

Facility

IP

$5,984.34

Service Code	APR-DRG 3462
Hospital Charge Code	APRDRG3462
Min. Negotiated Rate	$5,984.34
Max. Negotiated Rate	$5,984.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,984.34
Rate for Payer: Mercy Care Medicaid	$5,984.34
Rate for Payer: NaphCare Correctional Healthcare	$5,984.34

Connective Tissue Disorders

Facility

IP

$9,961.98

Service Code	APR-DRG 3463
Hospital Charge Code	APRDRG3463
Min. Negotiated Rate	$9,961.98
Max. Negotiated Rate	$9,961.98
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,961.98
Rate for Payer: Mercy Care Medicaid	$9,961.98
Rate for Payer: NaphCare Correctional Healthcare	$9,961.98

Connective Tissue Disorders

Facility

IP

$4,388.66

Service Code	APR-DRG 3461
Hospital Charge Code	APRDRG3461
Min. Negotiated Rate	$4,388.66
Max. Negotiated Rate	$4,388.66
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,388.66
Rate for Payer: Mercy Care Medicaid	$4,388.66
Rate for Payer: NaphCare Correctional Healthcare	$4,388.66

Connective Tissue Disorders

Facility

IP

$22,866.34

Service Code	APR-DRG 3464
Hospital Charge Code	APRDRG3463
Min. Negotiated Rate	$22,866.34
Max. Negotiated Rate	$22,866.34
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,866.34
Rate for Payer: Mercy Care Medicaid	$22,866.34
Rate for Payer: NaphCare Correctional Healthcare	$22,866.34

Connective Tissue Disorders

Facility

IP

$9,961.98

Service Code	APR-DRG 3463
Hospital Charge Code	APRDRG3462
Min. Negotiated Rate	$9,961.98
Max. Negotiated Rate	$9,961.98
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,961.98
Rate for Payer: Mercy Care Medicaid	$9,961.98
Rate for Payer: NaphCare Correctional Healthcare	$9,961.98

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