Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Intentional Self-Harm And Attempted Suicide

Facility

IP

$2,520.13

Service Code	APR-DRG 8171
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$2,520.13
Max. Negotiated Rate	$2,520.13
Rate for Payer: AHCCCS Medicaid	$2,520.13
Rate for Payer: Allwell Medicaid	$2,520.13
Rate for Payer: AZCH Complete Medicaid	$2,520.13
Rate for Payer: Banner UC Health Medicaid	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13

Intentional Self-Harm And Attempted Suicide

Facility

IP

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8173
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: AHCCCS Medicaid	$3,187.16
Rate for Payer: Allwell Medicaid	$3,187.16
Rate for Payer: AZCH Complete Medicaid	$3,187.16
Rate for Payer: Banner UC Health Medicaid	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16

Intentional Self-Harm And Attempted Suicide

Facility

IP

$2,520.13

Service Code	APR-DRG 8171
Hospital Charge Code	APRDRG8171
Min. Negotiated Rate	$2,520.13
Max. Negotiated Rate	$2,520.13
Rate for Payer: AHCCCS Medicaid	$2,520.13
Rate for Payer: Allwell Medicaid	$2,520.13
Rate for Payer: AZCH Complete Medicaid	$2,520.13
Rate for Payer: Banner UC Health Medicaid	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13

Intentional Self-Harm And Attempted Suicide

Facility

IP

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8171
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: AHCCCS Medicaid	$3,187.16
Rate for Payer: Allwell Medicaid	$3,187.16
Rate for Payer: AZCH Complete Medicaid	$3,187.16
Rate for Payer: Banner UC Health Medicaid	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16

Intentional Self-Harm And Attempted Suicide

Facility

IP

$10,416.49

Service Code	APR-DRG 8174
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$10,416.49
Max. Negotiated Rate	$10,416.49
Rate for Payer: AHCCCS Medicaid	$10,416.49
Rate for Payer: Allwell Medicaid	$10,416.49
Rate for Payer: AZCH Complete Medicaid	$10,416.49
Rate for Payer: Banner UC Health Medicaid	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49

Intentional Self-Harm And Attempted Suicide

Facility

IP

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: AHCCCS Medicaid	$5,210.00
Rate for Payer: Allwell Medicaid	$5,210.00
Rate for Payer: AZCH Complete Medicaid	$5,210.00
Rate for Payer: Banner UC Health Medicaid	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

IP

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8174
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: AHCCCS Medicaid	$3,187.16
Rate for Payer: Allwell Medicaid	$3,187.16
Rate for Payer: AZCH Complete Medicaid	$3,187.16
Rate for Payer: Banner UC Health Medicaid	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16

Intentional Self-Harm And Attempted Suicide

Facility

IP

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8174
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: AHCCCS Medicaid	$5,210.00
Rate for Payer: Allwell Medicaid	$5,210.00
Rate for Payer: AZCH Complete Medicaid	$5,210.00
Rate for Payer: Banner UC Health Medicaid	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

IP

$2,520.13

Service Code	APR-DRG 8171
Hospital Charge Code	APRDRG8173
Min. Negotiated Rate	$2,520.13
Max. Negotiated Rate	$2,520.13
Rate for Payer: AHCCCS Medicaid	$2,520.13
Rate for Payer: Allwell Medicaid	$2,520.13
Rate for Payer: AZCH Complete Medicaid	$2,520.13
Rate for Payer: Banner UC Health Medicaid	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13

Intentional Self-Harm And Attempted Suicide

Facility

IP

$10,416.49

Service Code	APR-DRG 8174
Hospital Charge Code	APRDRG8171
Min. Negotiated Rate	$10,416.49
Max. Negotiated Rate	$10,416.49
Rate for Payer: AHCCCS Medicaid	$10,416.49
Rate for Payer: Allwell Medicaid	$10,416.49
Rate for Payer: AZCH Complete Medicaid	$10,416.49
Rate for Payer: Banner UC Health Medicaid	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49

Intentional Self-Harm And Attempted Suicide

Facility

IP

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8173
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: AHCCCS Medicaid	$5,210.00
Rate for Payer: Allwell Medicaid	$5,210.00
Rate for Payer: AZCH Complete Medicaid	$5,210.00
Rate for Payer: Banner UC Health Medicaid	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

IP

$10,416.49

Service Code	APR-DRG 8174
Hospital Charge Code	APRDRG8173
Min. Negotiated Rate	$10,416.49
Max. Negotiated Rate	$10,416.49
Rate for Payer: AHCCCS Medicaid	$10,416.49
Rate for Payer: Allwell Medicaid	$10,416.49
Rate for Payer: AZCH Complete Medicaid	$10,416.49
Rate for Payer: Banner UC Health Medicaid	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49

INTERGUIDE TRACH TUBE INDUCER 6FR

Facility

IP

$55.00

Hospital Charge Code	27704487
Hospital Revenue Code	270
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

INTERGUIDE TRACH TUBE INDUCER 6FR

Facility

OP

$55.00

Hospital Charge Code	27704487
Hospital Revenue Code	270
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

INTERJECT CLEAR

Facility

OP

$111.00

Hospital Charge Code	23654595
Hospital Revenue Code	270
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Aetna of AZ Medicare	$31.08
Rate for Payer: Allwell Medicare	$16.65
Rate for Payer: Amerigroup Medicare	$16.65
Rate for Payer: APIPA Medicare/Medicaid	$41.46
Rate for Payer: AZCH Complete Medicare	$16.65
Rate for Payer: Banner UC Health Medicare	$16.65
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$75.48
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Copperpoint Commercial	$27.47
Rate for Payer: Health Net of AZ Commercial	$66.60
Rate for Payer: Health Net of AZ Medicare	$31.08
Rate for Payer: Humana of AZ Medicare	$16.65
Rate for Payer: Self Pay Self Pay	$88.80
Rate for Payer: TriWest Medicare	$16.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$64.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.98

INTERJECT CLEAR

Facility

OP

$305.00

Hospital Charge Code	27497397
Hospital Revenue Code	270
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Aetna of AZ Medicare	$85.40
Rate for Payer: Allwell Medicare	$45.75
Rate for Payer: Amerigroup Medicare	$45.75
Rate for Payer: APIPA Medicare/Medicaid	$113.92
Rate for Payer: AZCH Complete Medicare	$45.75
Rate for Payer: Banner UC Health Medicare	$45.75
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$207.40
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$213.50
Rate for Payer: Copperpoint Commercial	$75.49
Rate for Payer: Health Net of AZ Commercial	$183.00
Rate for Payer: Health Net of AZ Medicare	$85.40
Rate for Payer: Humana of AZ Medicare	$45.75
Rate for Payer: Self Pay Self Pay	$244.00
Rate for Payer: TriWest Medicare	$45.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$177.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.90

INTERJECT CLEAR

Facility

IP

$111.00

Hospital Charge Code	23654595
Hospital Revenue Code	270
Min. Negotiated Rate	$28.86
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Bisbee Police All Plans	$28.86
Rate for Payer: Cash Price	$88.80
Rate for Payer: Self Pay Self Pay	$88.80

INTERJECT CLEAR

Facility

IP

$305.00

Hospital Charge Code	27497397
Hospital Revenue Code	270
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Bisbee Police All Plans	$79.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Self Pay Self Pay	$244.00

INTERSTIM MICOR NEUROSTIMULATOR

Facility

IP

$12,264.00

Hospital Charge Code	27400596
Hospital Revenue Code	270
Min. Negotiated Rate	$3,188.64
Max. Negotiated Rate	$11,037.60
Rate for Payer: Aetna of AZ Commercial	$11,037.60
Rate for Payer: Bisbee Police All Plans	$3,188.64
Rate for Payer: Cash Price	$9,811.20
Rate for Payer: Self Pay Self Pay	$9,811.20

INTERSTIM MICOR NEUROSTIMULATOR

Facility

OP

$12,264.00

Hospital Charge Code	27400596
Hospital Revenue Code	270
Min. Negotiated Rate	$1,839.60
Max. Negotiated Rate	$11,037.60
Rate for Payer: Aetna of AZ Commercial	$11,037.60
Rate for Payer: Aetna of AZ Medicare	$3,433.92
Rate for Payer: Allwell Medicare	$1,839.60
Rate for Payer: Amerigroup Medicare	$1,839.60
Rate for Payer: APIPA Medicare/Medicaid	$4,580.60
Rate for Payer: AZCH Complete Medicare	$1,839.60
Rate for Payer: Banner UC Health Medicare	$1,839.60
Rate for Payer: Bisbee Police All Plans	$3,188.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8,339.52
Rate for Payer: Cash Price	$9,811.20
Rate for Payer: Cigna of AZ Commercial	$8,584.80
Rate for Payer: Copperpoint Commercial	$3,035.34
Rate for Payer: Health Net of AZ Commercial	$7,358.40
Rate for Payer: Health Net of AZ Medicare	$3,433.92
Rate for Payer: Humana of AZ Medicare	$1,839.60
Rate for Payer: Self Pay Self Pay	$9,811.20
Rate for Payer: TriWest Medicare	$1,839.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$7,149.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,207.52

INTERSTIM SMART PROGRAMMER KIT

Facility

OP

$10,238.00

Hospital Charge Code	27372826
Hospital Revenue Code	270
Min. Negotiated Rate	$1,535.70
Max. Negotiated Rate	$9,214.20
Rate for Payer: Aetna of AZ Commercial	$9,214.20
Rate for Payer: Aetna of AZ Medicare	$2,866.64
Rate for Payer: Allwell Medicare	$1,535.70
Rate for Payer: Amerigroup Medicare	$1,535.70
Rate for Payer: APIPA Medicare/Medicaid	$3,823.89
Rate for Payer: AZCH Complete Medicare	$1,535.70
Rate for Payer: Banner UC Health Medicare	$1,535.70
Rate for Payer: Bisbee Police All Plans	$2,661.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6,961.84
Rate for Payer: Cash Price	$8,190.40
Rate for Payer: Cigna of AZ Commercial	$7,166.60
Rate for Payer: Copperpoint Commercial	$2,533.90
Rate for Payer: Health Net of AZ Commercial	$6,142.80
Rate for Payer: Health Net of AZ Medicare	$2,866.64
Rate for Payer: Humana of AZ Medicare	$1,535.70
Rate for Payer: Self Pay Self Pay	$8,190.40
Rate for Payer: TriWest Medicare	$1,535.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,968.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,842.84

INTERSTIM SMART PROGRAMMER KIT

Facility

IP

$10,238.00

Hospital Charge Code	27372826
Hospital Revenue Code	270
Min. Negotiated Rate	$2,661.88
Max. Negotiated Rate	$9,214.20
Rate for Payer: Aetna of AZ Commercial	$9,214.20
Rate for Payer: Bisbee Police All Plans	$2,661.88
Rate for Payer: Cash Price	$8,190.40
Rate for Payer: Self Pay Self Pay	$8,190.40

INTERSTIM SURESCAN MRI LEAD KIT

Facility

OP

$23,909.00

Hospital Charge Code	27400595
Hospital Revenue Code	270
Min. Negotiated Rate	$3,586.35
Max. Negotiated Rate	$21,518.10
Rate for Payer: Aetna of AZ Commercial	$21,518.10
Rate for Payer: Aetna of AZ Medicare	$6,694.52
Rate for Payer: Allwell Medicare	$3,586.35
Rate for Payer: Amerigroup Medicare	$3,586.35
Rate for Payer: APIPA Medicare/Medicaid	$8,930.01
Rate for Payer: AZCH Complete Medicare	$3,586.35
Rate for Payer: Banner UC Health Medicare	$3,586.35
Rate for Payer: Bisbee Police All Plans	$6,216.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16,258.12
Rate for Payer: Cash Price	$19,127.20
Rate for Payer: Cigna of AZ Commercial	$16,736.30
Rate for Payer: Copperpoint Commercial	$5,917.48
Rate for Payer: Health Net of AZ Commercial	$14,345.40
Rate for Payer: Health Net of AZ Medicare	$6,694.52
Rate for Payer: Humana of AZ Medicare	$3,586.35
Rate for Payer: Self Pay Self Pay	$19,127.20
Rate for Payer: TriWest Medicare	$3,586.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$13,938.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$4,303.62

INTERSTIM SURESCAN MRI LEAD KIT

Facility

IP

$23,909.00

Hospital Charge Code	27400595
Hospital Revenue Code	270
Min. Negotiated Rate	$6,216.34
Max. Negotiated Rate	$21,518.10
Rate for Payer: Aetna of AZ Commercial	$21,518.10
Rate for Payer: Bisbee Police All Plans	$6,216.34
Rate for Payer: Cash Price	$19,127.20
Rate for Payer: Self Pay Self Pay	$19,127.20

INTERSTIM SURESCAN MRI LEAD KIT 33CM

Facility

OP

$23,909.00

Hospital Charge Code	27372827
Hospital Revenue Code	270
Min. Negotiated Rate	$3,586.35
Max. Negotiated Rate	$21,518.10
Rate for Payer: Aetna of AZ Commercial	$21,518.10
Rate for Payer: Aetna of AZ Medicare	$6,694.52
Rate for Payer: Allwell Medicare	$3,586.35
Rate for Payer: Amerigroup Medicare	$3,586.35
Rate for Payer: APIPA Medicare/Medicaid	$8,930.01
Rate for Payer: AZCH Complete Medicare	$3,586.35
Rate for Payer: Banner UC Health Medicare	$3,586.35
Rate for Payer: Bisbee Police All Plans	$6,216.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16,258.12
Rate for Payer: Cash Price	$19,127.20
Rate for Payer: Cigna of AZ Commercial	$16,736.30
Rate for Payer: Copperpoint Commercial	$5,917.48
Rate for Payer: Health Net of AZ Commercial	$14,345.40
Rate for Payer: Health Net of AZ Medicare	$6,694.52
Rate for Payer: Humana of AZ Medicare	$3,586.35
Rate for Payer: Self Pay Self Pay	$19,127.20
Rate for Payer: TriWest Medicare	$3,586.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$13,938.95
Rate for Payer: UnitedHealth Group of AZ Medicare	$4,303.62

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