Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NOMOLINE LH NASAL ORAL CO2 CANNUAL PED 7FT

Facility

OP

$74.00

Hospital Charge Code	27476056
Hospital Revenue Code	270
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Arizona Complete Health Allwell	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$50.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.84
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$51.80
Rate for Payer: Devoted Health Medicare	$13.32
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Southwest Service Administrators UFCW	$50.32
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: United Healthcare Commercial	$42.33
Rate for Payer: United Healthcare Medicare	$11.84
Rate for Payer: Veterans Affairs TRICARE	$11.72

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

IP

$29,659.60

Service Code	MSDRG 098
Min. Negotiated Rate	$29,659.60
Max. Negotiated Rate	$29,659.60
Rate for Payer: Seven Corners Travel Insurance	$29,659.60

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

IP

$46,679.40

Service Code	MSDRG 097
Min. Negotiated Rate	$46,679.40
Max. Negotiated Rate	$46,679.40
Rate for Payer: Seven Corners Travel Insurance	$46,679.40

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

IP

$17,618.66

Service Code	MSDRG 099
Min. Negotiated Rate	$17,618.66
Max. Negotiated Rate	$17,618.66
Rate for Payer: Seven Corners Travel Insurance	$17,618.66

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$8,018.40

Service Code	APR-DRG 0502
Hospital Charge Code	APRDRG0502
Min. Negotiated Rate	$8,018.40
Max. Negotiated Rate	$8,018.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,018.40
Rate for Payer: Mercy Care Medicaid	$8,018.40
Rate for Payer: NaphCare Correctional Healthcare	$8,018.40

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$4,423.73

Service Code	APR-DRG 0501
Hospital Charge Code	APRDRG0503
Min. Negotiated Rate	$4,423.73
Max. Negotiated Rate	$4,423.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,423.73
Rate for Payer: Mercy Care Medicaid	$4,423.73
Rate for Payer: NaphCare Correctional Healthcare	$4,423.73

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$4,423.73

Service Code	APR-DRG 0501
Hospital Charge Code	APRDRG0501
Min. Negotiated Rate	$4,423.73
Max. Negotiated Rate	$4,423.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,423.73
Rate for Payer: Mercy Care Medicaid	$4,423.73
Rate for Payer: NaphCare Correctional Healthcare	$4,423.73

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$28,429.85

Service Code	APR-DRG 0504
Hospital Charge Code	APRDRG0501
Min. Negotiated Rate	$28,429.85
Max. Negotiated Rate	$28,429.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,429.85
Rate for Payer: Mercy Care Medicaid	$28,429.85
Rate for Payer: NaphCare Correctional Healthcare	$28,429.85

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$4,423.73

Service Code	APR-DRG 0501
Hospital Charge Code	APRDRG0504
Min. Negotiated Rate	$4,423.73
Max. Negotiated Rate	$4,423.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,423.73
Rate for Payer: Mercy Care Medicaid	$4,423.73
Rate for Payer: NaphCare Correctional Healthcare	$4,423.73

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$8,018.40

Service Code	APR-DRG 0502
Hospital Charge Code	APRDRG0501
Min. Negotiated Rate	$8,018.40
Max. Negotiated Rate	$8,018.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,018.40
Rate for Payer: Mercy Care Medicaid	$8,018.40
Rate for Payer: NaphCare Correctional Healthcare	$8,018.40

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$8,018.40

Service Code	APR-DRG 0502
Hospital Charge Code	APRDRG0504
Min. Negotiated Rate	$8,018.40
Max. Negotiated Rate	$8,018.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,018.40
Rate for Payer: Mercy Care Medicaid	$8,018.40
Rate for Payer: NaphCare Correctional Healthcare	$8,018.40

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$14,022.39

Service Code	APR-DRG 0503
Hospital Charge Code	APRDRG0504
Min. Negotiated Rate	$14,022.39
Max. Negotiated Rate	$14,022.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,022.39
Rate for Payer: Mercy Care Medicaid	$14,022.39
Rate for Payer: NaphCare Correctional Healthcare	$14,022.39

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$28,429.85

Service Code	APR-DRG 0504
Hospital Charge Code	APRDRG0503
Min. Negotiated Rate	$28,429.85
Max. Negotiated Rate	$28,429.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,429.85
Rate for Payer: Mercy Care Medicaid	$28,429.85
Rate for Payer: NaphCare Correctional Healthcare	$28,429.85

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$4,423.73

Service Code	APR-DRG 0501
Hospital Charge Code	APRDRG0502
Min. Negotiated Rate	$4,423.73
Max. Negotiated Rate	$4,423.73
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,423.73
Rate for Payer: Mercy Care Medicaid	$4,423.73
Rate for Payer: NaphCare Correctional Healthcare	$4,423.73

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$28,429.85

Service Code	APR-DRG 0504
Hospital Charge Code	APRDRG0502
Min. Negotiated Rate	$28,429.85
Max. Negotiated Rate	$28,429.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,429.85
Rate for Payer: Mercy Care Medicaid	$28,429.85
Rate for Payer: NaphCare Correctional Healthcare	$28,429.85

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$28,429.85

Service Code	APR-DRG 0504
Hospital Charge Code	APRDRG0504
Min. Negotiated Rate	$28,429.85
Max. Negotiated Rate	$28,429.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$28,429.85
Rate for Payer: Mercy Care Medicaid	$28,429.85
Rate for Payer: NaphCare Correctional Healthcare	$28,429.85

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$14,022.39

Service Code	APR-DRG 0503
Hospital Charge Code	APRDRG0502
Min. Negotiated Rate	$14,022.39
Max. Negotiated Rate	$14,022.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,022.39
Rate for Payer: Mercy Care Medicaid	$14,022.39
Rate for Payer: NaphCare Correctional Healthcare	$14,022.39

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$14,022.39

Service Code	APR-DRG 0503
Hospital Charge Code	APRDRG0501
Min. Negotiated Rate	$14,022.39
Max. Negotiated Rate	$14,022.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,022.39
Rate for Payer: Mercy Care Medicaid	$14,022.39
Rate for Payer: NaphCare Correctional Healthcare	$14,022.39

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$8,018.40

Service Code	APR-DRG 0502
Hospital Charge Code	APRDRG0503
Min. Negotiated Rate	$8,018.40
Max. Negotiated Rate	$8,018.40
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$8,018.40
Rate for Payer: Mercy Care Medicaid	$8,018.40
Rate for Payer: NaphCare Correctional Healthcare	$8,018.40

Non-Bacterial Infections Of Nervous System Except Viral Meningitis

Facility

IP

$14,022.39

Service Code	APR-DRG 0503
Hospital Charge Code	APRDRG0503
Min. Negotiated Rate	$14,022.39
Max. Negotiated Rate	$14,022.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$14,022.39
Rate for Payer: Mercy Care Medicaid	$14,022.39
Rate for Payer: NaphCare Correctional Healthcare	$14,022.39

Non-Elective Or Complex Hip Joint Replacement

Facility

IP

$11,223.80

Service Code	APR-DRG 3232
Hospital Charge Code	APRDRG3233
Min. Negotiated Rate	$11,223.80
Max. Negotiated Rate	$11,223.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,223.80
Rate for Payer: Mercy Care Medicaid	$11,223.80
Rate for Payer: NaphCare Correctional Healthcare	$11,223.80

Non-Elective Or Complex Hip Joint Replacement

Facility

IP

$15,202.14

Service Code	APR-DRG 3233
Hospital Charge Code	APRDRG3234
Min. Negotiated Rate	$15,202.14
Max. Negotiated Rate	$15,202.14
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15,202.14
Rate for Payer: Mercy Care Medicaid	$15,202.14
Rate for Payer: NaphCare Correctional Healthcare	$15,202.14

Non-Elective Or Complex Hip Joint Replacement

Facility

IP

$11,223.80

Service Code	APR-DRG 3232
Hospital Charge Code	APRDRG3232
Min. Negotiated Rate	$11,223.80
Max. Negotiated Rate	$11,223.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,223.80
Rate for Payer: Mercy Care Medicaid	$11,223.80
Rate for Payer: NaphCare Correctional Healthcare	$11,223.80

Non-Elective Or Complex Hip Joint Replacement

Facility

IP

$9,893.25

Service Code	APR-DRG 3231
Hospital Charge Code	APRDRG3231
Min. Negotiated Rate	$9,893.25
Max. Negotiated Rate	$9,893.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$9,893.25
Rate for Payer: Mercy Care Medicaid	$9,893.25
Rate for Payer: NaphCare Correctional Healthcare	$9,893.25

Non-Elective Or Complex Hip Joint Replacement

Facility

IP

$22,891.59

Service Code	APR-DRG 3234
Hospital Charge Code	APRDRG3233
Min. Negotiated Rate	$22,891.59
Max. Negotiated Rate	$22,891.59
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22,891.59
Rate for Payer: Mercy Care Medicaid	$22,891.59
Rate for Payer: NaphCare Correctional Healthcare	$22,891.59

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