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	APRDRG8174
Min. Negotiated Rate	$2,520.13
Max. Negotiated Rate	$2,520.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13
Rate for Payer: NaphCare Correctional Healthcare	$2,520.13

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: Blue Cross Blue Shield of Arizona Health Choice	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13
Rate for Payer: NaphCare Correctional Healthcare	$2,520.13

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: Blue Cross Blue Shield of Arizona Health Choice	$2,520.13
Rate for Payer: Mercy Care Medicaid	$2,520.13
Rate for Payer: NaphCare Correctional Healthcare	$2,520.13

Intentional Self-Harm And Attempted Suicide

Facility

IP

$5,210.00

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG8171
Min. Negotiated Rate	$5,210.00
Max. Negotiated Rate	$5,210.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49
Rate for Payer: NaphCare Correctional Healthcare	$10,416.49

Intentional Self-Harm And Attempted Suicide

Facility

IP

$3,187.16

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG8172
Min. Negotiated Rate	$3,187.16
Max. Negotiated Rate	$3,187.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,187.16
Rate for Payer: Mercy Care Medicaid	$3,187.16
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49
Rate for Payer: NaphCare Correctional Healthcare	$10,416.49

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: Blue Cross Blue Shield of Arizona Health Choice	$5,210.00
Rate for Payer: Mercy Care Medicaid	$5,210.00
Rate for Payer: NaphCare Correctional Healthcare	$5,210.00

Intentional Self-Harm And Attempted Suicide

Facility

IP

$10,416.49

Service Code	APR-DRG 8174
Hospital Charge Code	APRDRG8174
Min. Negotiated Rate	$10,416.49
Max. Negotiated Rate	$10,416.49
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,416.49
Rate for Payer: Mercy Care Medicaid	$10,416.49
Rate for Payer: NaphCare Correctional Healthcare	$10,416.49

INTERDRY AG TEXTILE 10X36

Facility

IP

$165.32

Hospital Charge Code	27880401
Hospital Revenue Code	270
Min. Negotiated Rate	$148.79
Max. Negotiated Rate	$148.79
Rate for Payer: Aetna of AZ Commercial	$148.79
Rate for Payer: Cash Price	$132.26

INTERDRY AG TEXTILE 10X36

Facility

OP

$165.32

Hospital Charge Code	27880401
Hospital Revenue Code	270
Min. Negotiated Rate	$26.19
Max. Negotiated Rate	$148.79
Rate for Payer: Aetna of AZ Commercial	$148.79
Rate for Payer: Arizona Complete Health Allwell	$26.45
Rate for Payer: Banner UC Health Medicare	$26.45
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$112.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.45
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.45
Rate for Payer: Cash Price	$132.26
Rate for Payer: Cigna of AZ Commercial	$115.72
Rate for Payer: Devoted Health Medicare	$29.76
Rate for Payer: Humana of AZ Medicare	$26.45
Rate for Payer: Southwest Service Administrators UFCW	$112.42
Rate for Payer: TriWest Medicare	$26.45
Rate for Payer: United Healthcare Commercial	$94.56
Rate for Payer: United Healthcare Medicare	$26.45
Rate for Payer: Veterans Affairs TRICARE	$26.19

INTERGUIDE TRACH TUBE INDUCER 6FR

Facility

OP

$55.00

Hospital Charge Code	27704487
Hospital Revenue Code	270
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Arizona Complete Health Allwell	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$37.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.80
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$38.50
Rate for Payer: Devoted Health Medicare	$9.90
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Southwest Service Administrators UFCW	$37.40
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: United Healthcare Commercial	$31.46
Rate for Payer: United Healthcare Medicare	$8.80
Rate for Payer: Veterans Affairs TRICARE	$8.71

INTERGUIDE TRACH TUBE INDUCER 6FR

Facility

IP

$55.00

Hospital Charge Code	27704487
Hospital Revenue Code	270
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Cash Price	$44.00

INTERJECT CLEAR

Facility

IP

$305.00

Hospital Charge Code	27497397
Hospital Revenue Code	270
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Cash Price	$244.00

INTERJECT CLEAR

Facility

OP

$111.00

Hospital Charge Code	23654595
Hospital Revenue Code	270
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Arizona Complete Health Allwell	$17.76
Rate for Payer: Banner UC Health Medicare	$17.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$75.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$17.76
Rate for Payer: Cash Price	$88.80
Rate for Payer: Cigna of AZ Commercial	$77.70
Rate for Payer: Devoted Health Medicare	$19.98
Rate for Payer: Humana of AZ Medicare	$17.76
Rate for Payer: Southwest Service Administrators UFCW	$75.48
Rate for Payer: TriWest Medicare	$17.76
Rate for Payer: United Healthcare Commercial	$63.49
Rate for Payer: United Healthcare Medicare	$17.76
Rate for Payer: Veterans Affairs TRICARE	$17.58

INTERJECT CLEAR

Facility

OP

$305.00

Hospital Charge Code	27497397
Hospital Revenue Code	270
Min. Negotiated Rate	$48.31
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna of AZ Commercial	$274.50
Rate for Payer: Arizona Complete Health Allwell	$48.80
Rate for Payer: Banner UC Health Medicare	$48.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$207.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.80
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cigna of AZ Commercial	$213.50
Rate for Payer: Devoted Health Medicare	$54.90
Rate for Payer: Humana of AZ Medicare	$48.80
Rate for Payer: Southwest Service Administrators UFCW	$207.40
Rate for Payer: TriWest Medicare	$48.80
Rate for Payer: United Healthcare Commercial	$174.46
Rate for Payer: United Healthcare Medicare	$48.80
Rate for Payer: Veterans Affairs TRICARE	$48.31

INTERJECT CLEAR

Facility

IP

$111.00

Hospital Charge Code	23654595
Hospital Revenue Code	270
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna of AZ Commercial	$99.90
Rate for Payer: Cash Price	$88.80

INTERSTIM MICOR NEUROSTIMULATOR

Facility

OP

$12,264.00

Hospital Charge Code	27400596
Hospital Revenue Code	270
Min. Negotiated Rate	$1,942.62
Max. Negotiated Rate	$11,037.60
Rate for Payer: Aetna of AZ Commercial	$11,037.60
Rate for Payer: Arizona Complete Health Allwell	$1,962.24
Rate for Payer: Banner UC Health Medicare	$1,962.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$8,339.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,962.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,962.24
Rate for Payer: Cash Price	$9,811.20
Rate for Payer: Cigna of AZ Commercial	$8,584.80
Rate for Payer: Devoted Health Medicare	$2,207.52
Rate for Payer: Humana of AZ Medicare	$1,962.24
Rate for Payer: Southwest Service Administrators UFCW	$8,339.52
Rate for Payer: TriWest Medicare	$1,962.24
Rate for Payer: United Healthcare Commercial	$7,015.01
Rate for Payer: United Healthcare Medicare	$1,962.24
Rate for Payer: Veterans Affairs TRICARE	$1,942.62

INTERSTIM MICOR NEUROSTIMULATOR

Facility

IP

$12,264.00

Hospital Charge Code	27400596
Hospital Revenue Code	270
Min. Negotiated Rate	$11,037.60
Max. Negotiated Rate	$11,037.60
Rate for Payer: Aetna of AZ Commercial	$11,037.60
Rate for Payer: Cash Price	$9,811.20

INTERSTIM SURESCAN MRI LEAD KIT

Facility

IP

$23,909.00

Hospital Charge Code	27400595
Hospital Revenue Code	270
Min. Negotiated Rate	$21,518.10
Max. Negotiated Rate	$21,518.10
Rate for Payer: Aetna of AZ Commercial	$21,518.10
Rate for Payer: Cash Price	$19,127.20

INTERSTIM SURESCAN MRI LEAD KIT

Facility

OP

$23,909.00

Hospital Charge Code	27400595
Hospital Revenue Code	270
Min. Negotiated Rate	$3,787.19
Max. Negotiated Rate	$21,518.10
Rate for Payer: Aetna of AZ Commercial	$21,518.10
Rate for Payer: Arizona Complete Health Allwell	$3,825.44
Rate for Payer: Banner UC Health Medicare	$3,825.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$16,258.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$3,825.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$3,825.44
Rate for Payer: Cash Price	$19,127.20
Rate for Payer: Cigna of AZ Commercial	$16,736.30
Rate for Payer: Devoted Health Medicare	$4,303.62
Rate for Payer: Humana of AZ Medicare	$3,825.44
Rate for Payer: Southwest Service Administrators UFCW	$16,258.12
Rate for Payer: TriWest Medicare	$3,825.44
Rate for Payer: United Healthcare Commercial	$13,675.95
Rate for Payer: United Healthcare Medicare	$3,825.44
Rate for Payer: Veterans Affairs TRICARE	$3,787.19

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: Blue Cross Blue Shield of Arizona Health Choice	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89
Rate for Payer: NaphCare Correctional Healthcare	$7,159.89

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: Blue Cross Blue Shield of Arizona Health Choice	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89
Rate for Payer: NaphCare Correctional Healthcare	$7,159.89

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: Blue Cross Blue Shield of Arizona Health Choice	$7,159.89
Rate for Payer: Mercy Care Medicaid	$7,159.89
Rate for Payer: NaphCare Correctional Healthcare	$7,159.89

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: Blue Cross Blue Shield of Arizona Health Choice	$11,037.93
Rate for Payer: Mercy Care Medicaid	$11,037.93
Rate for Payer: NaphCare Correctional Healthcare	$11,037.93

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