Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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

INTERSTIM X NEUROSTIMULATOR

Facility

IP

$64,240.00

Hospital Charge Code	27372825
Hospital Revenue Code	270
Min. Negotiated Rate	$16,702.40
Max. Negotiated Rate	$57,816.00
Rate for Payer: Aetna of AZ Commercial	$57,816.00
Rate for Payer: Bisbee Police All Plans	$16,702.40
Rate for Payer: Cash Price	$51,392.00
Rate for Payer: Self Pay Self Pay	$51,392.00

INTERSTIM X NEUROSTIMULATOR

Facility

OP

$64,240.00

Hospital Charge Code	27372825
Hospital Revenue Code	270
Min. Negotiated Rate	$9,636.00
Max. Negotiated Rate	$57,816.00
Rate for Payer: Aetna of AZ Commercial	$57,816.00
Rate for Payer: Aetna of AZ Medicare	$17,987.20
Rate for Payer: Allwell Medicare	$9,636.00
Rate for Payer: Amerigroup Medicare	$9,636.00
Rate for Payer: APIPA Medicare/Medicaid	$23,993.64
Rate for Payer: AZCH Complete Medicare	$9,636.00
Rate for Payer: Banner UC Health Medicare	$9,636.00
Rate for Payer: Bisbee Police All Plans	$16,702.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43,683.20
Rate for Payer: Cash Price	$51,392.00
Rate for Payer: Cigna of AZ Commercial	$44,968.00
Rate for Payer: Copperpoint Commercial	$15,899.40
Rate for Payer: Health Net of AZ Commercial	$38,544.00
Rate for Payer: Health Net of AZ Medicare	$17,987.20
Rate for Payer: Humana of AZ Medicare	$9,636.00
Rate for Payer: Self Pay Self Pay	$51,392.00
Rate for Payer: TriWest Medicare	$9,636.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$37,451.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$11,563.20

Interstitial And Alveolar Lung Diseases

Facility

IP

$11,037.93

Service Code	APR-DRG 1424
Hospital Charge Code	APRDRG1423
Min. Negotiated Rate	$11,037.93
Max. Negotiated Rate	$11,037.93
Rate for Payer: AHCCCS Medicaid	$11,037.93
Rate for Payer: Allwell Medicaid	$11,037.93
Rate for Payer: AZCH Complete Medicaid	$11,037.93
Rate for Payer: Banner UC Health Medicaid	$11,037.93
Rate for Payer: Mercy Care Medicaid	$11,037.93

Interstitial And Alveolar Lung Diseases

Facility

IP

$7,159.89

Service Code	APR-DRG 1423
Hospital Charge Code	APRDRG1424
Min. Negotiated Rate	$7,159.89
Max. Negotiated Rate	$7,159.89
Rate for Payer: AHCCCS Medicaid	$7,159.89
Rate for Payer: Allwell Medicaid	$7,159.89
Rate for Payer: AZCH Complete Medicaid	$7,159.89
Rate for Payer: Banner UC Health Medicaid	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89

Interstitial And Alveolar Lung Diseases

Facility

IP

$5,221.22

Service Code	APR-DRG 1422
Hospital Charge Code	APRDRG1423
Min. Negotiated Rate	$5,221.22
Max. Negotiated Rate	$5,221.22
Rate for Payer: AHCCCS Medicaid	$5,221.22
Rate for Payer: Allwell Medicaid	$5,221.22
Rate for Payer: AZCH Complete Medicaid	$5,221.22
Rate for Payer: Banner UC Health Medicaid	$5,221.22
Rate for Payer: Mercy Care Medicaid	$5,221.22

Interstitial And Alveolar Lung Diseases

Facility

IP

$5,221.22

Service Code	APR-DRG 1422
Hospital Charge Code	APRDRG1424
Min. Negotiated Rate	$5,221.22
Max. Negotiated Rate	$5,221.22
Rate for Payer: AHCCCS Medicaid	$5,221.22
Rate for Payer: Allwell Medicaid	$5,221.22
Rate for Payer: AZCH Complete Medicaid	$5,221.22
Rate for Payer: Banner UC Health Medicaid	$5,221.22
Rate for Payer: Mercy Care Medicaid	$5,221.22

Interstitial And Alveolar Lung Diseases

Facility

IP

$11,037.93

Service Code	APR-DRG 1424
Hospital Charge Code	APRDRG1422
Min. Negotiated Rate	$11,037.93
Max. Negotiated Rate	$11,037.93
Rate for Payer: AHCCCS Medicaid	$11,037.93
Rate for Payer: Allwell Medicaid	$11,037.93
Rate for Payer: AZCH Complete Medicaid	$11,037.93
Rate for Payer: Banner UC Health Medicaid	$11,037.93
Rate for Payer: Mercy Care Medicaid	$11,037.93

Interstitial And Alveolar Lung Diseases

Facility

IP

$4,035.15

Service Code	APR-DRG 1421
Hospital Charge Code	APRDRG1422
Min. Negotiated Rate	$4,035.15
Max. Negotiated Rate	$4,035.15
Rate for Payer: AHCCCS Medicaid	$4,035.15
Rate for Payer: Allwell Medicaid	$4,035.15
Rate for Payer: AZCH Complete Medicaid	$4,035.15
Rate for Payer: Banner UC Health Medicaid	$4,035.15
Rate for Payer: Mercy Care Medicaid	$4,035.15

Interstitial And Alveolar Lung Diseases

Facility

IP

$7,159.89

Service Code	APR-DRG 1423
Hospital Charge Code	APRDRG1422
Min. Negotiated Rate	$7,159.89
Max. Negotiated Rate	$7,159.89
Rate for Payer: AHCCCS Medicaid	$7,159.89
Rate for Payer: Allwell Medicaid	$7,159.89
Rate for Payer: AZCH Complete Medicaid	$7,159.89
Rate for Payer: Banner UC Health Medicaid	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89

Interstitial And Alveolar Lung Diseases

Facility

IP

$4,035.15

Service Code	APR-DRG 1421
Hospital Charge Code	APRDRG1423
Min. Negotiated Rate	$4,035.15
Max. Negotiated Rate	$4,035.15
Rate for Payer: AHCCCS Medicaid	$4,035.15
Rate for Payer: Allwell Medicaid	$4,035.15
Rate for Payer: AZCH Complete Medicaid	$4,035.15
Rate for Payer: Banner UC Health Medicaid	$4,035.15
Rate for Payer: Mercy Care Medicaid	$4,035.15

Interstitial And Alveolar Lung Diseases

Facility

IP

$11,037.93

Service Code	APR-DRG 1424
Hospital Charge Code	APRDRG1424
Min. Negotiated Rate	$11,037.93
Max. Negotiated Rate	$11,037.93
Rate for Payer: AHCCCS Medicaid	$11,037.93
Rate for Payer: Allwell Medicaid	$11,037.93
Rate for Payer: AZCH Complete Medicaid	$11,037.93
Rate for Payer: Banner UC Health Medicaid	$11,037.93
Rate for Payer: Mercy Care Medicaid	$11,037.93

Interstitial And Alveolar Lung Diseases

Facility

IP

$5,221.22

Service Code	APR-DRG 1422
Hospital Charge Code	APRDRG1422
Min. Negotiated Rate	$5,221.22
Max. Negotiated Rate	$5,221.22
Rate for Payer: AHCCCS Medicaid	$5,221.22
Rate for Payer: Allwell Medicaid	$5,221.22
Rate for Payer: AZCH Complete Medicaid	$5,221.22
Rate for Payer: Banner UC Health Medicaid	$5,221.22
Rate for Payer: Mercy Care Medicaid	$5,221.22

Interstitial And Alveolar Lung Diseases

Facility

IP

$11,037.93

Service Code	APR-DRG 1424
Hospital Charge Code	APRDRG1421
Min. Negotiated Rate	$11,037.93
Max. Negotiated Rate	$11,037.93
Rate for Payer: AHCCCS Medicaid	$11,037.93
Rate for Payer: Allwell Medicaid	$11,037.93
Rate for Payer: AZCH Complete Medicaid	$11,037.93
Rate for Payer: Banner UC Health Medicaid	$11,037.93
Rate for Payer: Mercy Care Medicaid	$11,037.93

Interstitial And Alveolar Lung Diseases

Facility

IP

$7,159.89

Service Code	APR-DRG 1423
Hospital Charge Code	APRDRG1423
Min. Negotiated Rate	$7,159.89
Max. Negotiated Rate	$7,159.89
Rate for Payer: AHCCCS Medicaid	$7,159.89
Rate for Payer: Allwell Medicaid	$7,159.89
Rate for Payer: AZCH Complete Medicaid	$7,159.89
Rate for Payer: Banner UC Health Medicaid	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89

Interstitial And Alveolar Lung Diseases

Facility

IP

$4,035.15

Service Code	APR-DRG 1421
Hospital Charge Code	APRDRG1424
Min. Negotiated Rate	$4,035.15
Max. Negotiated Rate	$4,035.15
Rate for Payer: AHCCCS Medicaid	$4,035.15
Rate for Payer: Allwell Medicaid	$4,035.15
Rate for Payer: AZCH Complete Medicaid	$4,035.15
Rate for Payer: Banner UC Health Medicaid	$4,035.15
Rate for Payer: Mercy Care Medicaid	$4,035.15

Interstitial And Alveolar Lung Diseases

Facility

IP

$7,159.89

Service Code	APR-DRG 1423
Hospital Charge Code	APRDRG1421
Min. Negotiated Rate	$7,159.89
Max. Negotiated Rate	$7,159.89
Rate for Payer: AHCCCS Medicaid	$7,159.89
Rate for Payer: Allwell Medicaid	$7,159.89
Rate for Payer: AZCH Complete Medicaid	$7,159.89
Rate for Payer: Banner UC Health Medicaid	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89

Interstitial And Alveolar Lung Diseases

Facility

IP

$5,221.22

Service Code	APR-DRG 1422
Hospital Charge Code	APRDRG1421
Min. Negotiated Rate	$5,221.22
Max. Negotiated Rate	$5,221.22
Rate for Payer: AHCCCS Medicaid	$5,221.22
Rate for Payer: Allwell Medicaid	$5,221.22
Rate for Payer: AZCH Complete Medicaid	$5,221.22
Rate for Payer: Banner UC Health Medicaid	$5,221.22
Rate for Payer: Mercy Care Medicaid	$5,221.22

Interstitial And Alveolar Lung Diseases

Facility

IP

$4,035.15

Service Code	APR-DRG 1421
Hospital Charge Code	APRDRG1421
Min. Negotiated Rate	$4,035.15
Max. Negotiated Rate	$4,035.15
Rate for Payer: AHCCCS Medicaid	$4,035.15
Rate for Payer: Allwell Medicaid	$4,035.15
Rate for Payer: AZCH Complete Medicaid	$4,035.15
Rate for Payer: Banner UC Health Medicaid	$4,035.15
Rate for Payer: Mercy Care Medicaid	$4,035.15

Intervertebral Disc Excision And Decompression

Facility

IP

$7,417.31

Service Code	APR-DRG 3101
Hospital Charge Code	APRDRG3101
Min. Negotiated Rate	$7,417.31
Max. Negotiated Rate	$7,417.31
Rate for Payer: AHCCCS Medicaid	$7,417.31
Rate for Payer: Allwell Medicaid	$7,417.31
Rate for Payer: AZCH Complete Medicaid	$7,417.31
Rate for Payer: Banner UC Health Medicaid	$7,417.31
Rate for Payer: Mercy Care Medicaid	$7,417.31

Intervertebral Disc Excision And Decompression

Facility

IP

$13,581.91

Service Code	APR-DRG 3103
Hospital Charge Code	APRDRG3102
Min. Negotiated Rate	$13,581.91
Max. Negotiated Rate	$13,581.91
Rate for Payer: AHCCCS Medicaid	$13,581.91
Rate for Payer: Allwell Medicaid	$13,581.91
Rate for Payer: AZCH Complete Medicaid	$13,581.91
Rate for Payer: Banner UC Health Medicaid	$13,581.91
Rate for Payer: Mercy Care Medicaid	$13,581.91

Intervertebral Disc Excision And Decompression

Facility

IP

$13,581.91

Service Code	APR-DRG 3103
Hospital Charge Code	APRDRG3104
Min. Negotiated Rate	$13,581.91
Max. Negotiated Rate	$13,581.91
Rate for Payer: AHCCCS Medicaid	$13,581.91
Rate for Payer: Allwell Medicaid	$13,581.91
Rate for Payer: AZCH Complete Medicaid	$13,581.91
Rate for Payer: Banner UC Health Medicaid	$13,581.91
Rate for Payer: Mercy Care Medicaid	$13,581.91

Intervertebral Disc Excision And Decompression

Facility

IP

$13,581.91

Service Code	APR-DRG 3103
Hospital Charge Code	APRDRG3101
Min. Negotiated Rate	$13,581.91
Max. Negotiated Rate	$13,581.91
Rate for Payer: AHCCCS Medicaid	$13,581.91
Rate for Payer: Allwell Medicaid	$13,581.91
Rate for Payer: AZCH Complete Medicaid	$13,581.91
Rate for Payer: Banner UC Health Medicaid	$13,581.91
Rate for Payer: Mercy Care Medicaid	$13,581.91

Intervertebral Disc Excision And Decompression

Facility

IP

$7,417.31

Service Code	APR-DRG 3101
Hospital Charge Code	APRDRG3104
Min. Negotiated Rate	$7,417.31
Max. Negotiated Rate	$7,417.31
Rate for Payer: AHCCCS Medicaid	$7,417.31
Rate for Payer: Allwell Medicaid	$7,417.31
Rate for Payer: AZCH Complete Medicaid	$7,417.31
Rate for Payer: Banner UC Health Medicaid	$7,417.31
Rate for Payer: Mercy Care Medicaid	$7,417.31

Intervertebral Disc Excision And Decompression

Facility

IP

$9,515.89

Service Code	APR-DRG 3102
Hospital Charge Code	APRDRG3102
Min. Negotiated Rate	$9,515.89
Max. Negotiated Rate	$9,515.89
Rate for Payer: AHCCCS Medicaid	$9,515.89
Rate for Payer: Allwell Medicaid	$9,515.89
Rate for Payer: AZCH Complete Medicaid	$9,515.89
Rate for Payer: Banner UC Health Medicaid	$9,515.89
Rate for Payer: Mercy Care Medicaid	$9,515.89

<<
<
231
232
233
234
235
236
237
238
239
240
>
>>