Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

IP

$11,450.36

Service Code	APR-DRG 1712
Hospital Charge Code	APRDRG1711
Min. Negotiated Rate	$11,450.36
Max. Negotiated Rate	$11,450.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,450.36
Rate for Payer: Mercy Care Medicaid	$11,450.36
Rate for Payer: NaphCare Correctional Healthcare	$11,450.36

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

IP

$24,199.00

Service Code	APR-DRG 1714
Hospital Charge Code	APRDRG1713
Min. Negotiated Rate	$24,199.00
Max. Negotiated Rate	$24,199.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$24,199.00
Rate for Payer: Mercy Care Medicaid	$24,199.00
Rate for Payer: NaphCare Correctional Healthcare	$24,199.00

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

IP

$10,013.89

Service Code	APR-DRG 1711
Hospital Charge Code	APRDRG1713
Min. Negotiated Rate	$10,013.89
Max. Negotiated Rate	$10,013.89
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,013.89
Rate for Payer: Mercy Care Medicaid	$10,013.89
Rate for Payer: NaphCare Correctional Healthcare	$10,013.89

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

IP

$24,199.00

Service Code	APR-DRG 1714
Hospital Charge Code	APRDRG1714
Min. Negotiated Rate	$24,199.00
Max. Negotiated Rate	$24,199.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$24,199.00
Rate for Payer: Mercy Care Medicaid	$24,199.00
Rate for Payer: NaphCare Correctional Healthcare	$24,199.00

Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock

Facility

IP

$11,450.36

Service Code	APR-DRG 1712
Hospital Charge Code	APRDRG1712
Min. Negotiated Rate	$11,450.36
Max. Negotiated Rate	$11,450.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$11,450.36
Rate for Payer: Mercy Care Medicaid	$11,450.36
Rate for Payer: NaphCare Correctional Healthcare	$11,450.36

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

IP

$23,360.40

Service Code	MSDRG 244
Min. Negotiated Rate	$23,360.40
Max. Negotiated Rate	$23,360.40
Rate for Payer: Seven Corners Travel Insurance	$23,360.40

PESSARY INTEGRA MILTEX DISH SIZE 3 SILICONE

Facility

OP

$207.13

Hospital Charge Code	29522689
Hospital Revenue Code	270
Min. Negotiated Rate	$32.81
Max. Negotiated Rate	$186.42
Rate for Payer: Aetna of AZ Commercial	$186.42
Rate for Payer: Arizona Complete Health Allwell	$33.14
Rate for Payer: Banner UC Health Medicare	$33.14
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$140.85
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$33.14
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.14
Rate for Payer: Cash Price	$165.70
Rate for Payer: Cigna of AZ Commercial	$144.99
Rate for Payer: Devoted Health Medicare	$37.28
Rate for Payer: Humana of AZ Medicare	$33.14
Rate for Payer: Southwest Service Administrators UFCW	$140.85
Rate for Payer: TriWest Medicare	$33.14
Rate for Payer: United Healthcare Commercial	$118.48
Rate for Payer: United Healthcare Medicare	$33.14
Rate for Payer: Veterans Affairs TRICARE	$32.81

PESSARY INTEGRA MILTEX DISH SIZE 3 SILICONE

Facility

IP

$207.13

Hospital Charge Code	29522689
Hospital Revenue Code	270
Min. Negotiated Rate	$186.42
Max. Negotiated Rate	$186.42
Rate for Payer: Aetna of AZ Commercial	$186.42
Rate for Payer: Cash Price	$165.70

PESSARY, NON-RUBBER ANY TYPE

Facility

OP

$296.00

Service Code	HCPCS A4562
Hospital Charge Code	22951059
Hospital Revenue Code	278
Min. Negotiated Rate	$46.89
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Arizona Complete Health Allwell	$47.36
Rate for Payer: Banner UC Health Medicare	$47.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$201.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$47.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$47.36
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cigna of AZ Commercial	$148.00
Rate for Payer: Devoted Health Medicare	$53.28
Rate for Payer: Humana of AZ Medicare	$47.36
Rate for Payer: Southwest Service Administrators UFCW	$201.28
Rate for Payer: TriWest Medicare	$47.36
Rate for Payer: United Healthcare Commercial	$169.31
Rate for Payer: United Healthcare Medicare	$47.36
Rate for Payer: Veterans Affairs TRICARE	$46.89

PESSARY, NON-RUBBER ANY TYPE

Facility

IP

$296.00

Service Code	HCPCS A4562
Hospital Charge Code	22951059
Hospital Revenue Code	278
Min. Negotiated Rate	$266.40
Max. Negotiated Rate	$266.40
Rate for Payer: Aetna of AZ Commercial	$266.40
Rate for Payer: Cash Price	$236.80

Pfizer Comirnaty COVID 19 12 years and older

Facility

IP

$168.36

Service Code	CPT 91320
Hospital Charge Code	28132209
Hospital Revenue Code	521
Min. Negotiated Rate	$151.52
Max. Negotiated Rate	$151.52
Rate for Payer: Aetna of AZ Commercial	$151.52
Rate for Payer: Cash Price	$134.69

Pfizer Comirnaty COVID 19 12 years and older

Facility

OP

$168.36

Service Code	CPT 91320
Hospital Charge Code	28132209
Hospital Revenue Code	521
Min. Negotiated Rate	$26.67
Max. Negotiated Rate	$151.52
Rate for Payer: Aetna of AZ Commercial	$151.52
Rate for Payer: Arizona Complete Health Allwell	$26.94
Rate for Payer: Banner UC Health Medicare	$26.94
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.94
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.94
Rate for Payer: Cash Price	$134.69
Rate for Payer: Cigna of AZ Commercial	$117.85
Rate for Payer: Devoted Health Medicare	$30.30
Rate for Payer: Humana of AZ Medicare	$26.94
Rate for Payer: Southwest Service Administrators UFCW	$114.48
Rate for Payer: TriWest Medicare	$26.94
Rate for Payer: United Healthcare Commercial	$96.30
Rate for Payer: United Healthcare Medicare	$26.94
Rate for Payer: Veterans Affairs TRICARE	$26.67

Pfizer Comirnaty COVID 19 6months to 11 years

Facility

IP

$94.80

Service Code	CPT 91319
Hospital Charge Code	28127443
Hospital Revenue Code	521
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna of AZ Commercial	$85.32
Rate for Payer: Cash Price	$75.84

Pfizer Comirnaty COVID 19 6months to 11 years

Facility

OP

$94.80

Service Code	CPT 91319
Hospital Charge Code	28127443
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna of AZ Commercial	$85.32
Rate for Payer: Arizona Complete Health Allwell	$15.17
Rate for Payer: Banner UC Health Medicare	$15.17
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$64.46
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$15.17
Rate for Payer: Care1st Health Plan Arizona Medicare	$15.17
Rate for Payer: Cash Price	$75.84
Rate for Payer: Cigna of AZ Commercial	$66.36
Rate for Payer: Devoted Health Medicare	$17.06
Rate for Payer: Humana of AZ Medicare	$15.17
Rate for Payer: Southwest Service Administrators UFCW	$64.46
Rate for Payer: TriWest Medicare	$15.17
Rate for Payer: United Healthcare Commercial	$54.23
Rate for Payer: United Healthcare Medicare	$15.17
Rate for Payer: Veterans Affairs TRICARE	$15.02

Pfizer Pediatric First Dose

Facility

OP

$55.00

Service Code	CPT 0071A
Hospital Charge Code	24409112
Hospital Revenue Code	521
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

Pfizer Pediatric First Dose

Facility

IP

$55.00

Service Code	CPT 0071A
Hospital Charge Code	24409112
Hospital Revenue Code	521
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

Pfizer Third dose

Facility

IP

$53.00

Service Code	CPT 0003A
Hospital Charge Code	24381661
Hospital Revenue Code	521
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Cash Price	$42.40

Pfizer Third dose

Facility

OP

$53.00

Service Code	CPT 0003A
Hospital Charge Code	24381661
Hospital Revenue Code	521
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Arizona Complete Health Allwell	$8.48
Rate for Payer: Banner UC Health Medicare	$8.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$36.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Humana of AZ Medicare	$8.48
Rate for Payer: Southwest Service Administrators UFCW	$36.04
Rate for Payer: TriWest Medicare	$8.48
Rate for Payer: United Healthcare Commercial	$30.32
Rate for Payer: United Healthcare Medicare	$8.48
Rate for Payer: Veterans Affairs TRICARE	$8.40

PFT Pre Post

Facility

IP

$898.00

Service Code	CPT 94060
Hospital Charge Code	15513379
Hospital Revenue Code	460
Min. Negotiated Rate	$808.20
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Cash Price	$718.40

PFT Pre Post

Facility

OP

$898.00

Service Code	CPT 94060
Hospital Charge Code	15513379
Hospital Revenue Code	460
Min. Negotiated Rate	$142.24
Max. Negotiated Rate	$808.20
Rate for Payer: Aetna of AZ Commercial	$808.20
Rate for Payer: Arizona Complete Health Allwell	$143.68
Rate for Payer: Banner UC Health Medicare	$143.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$610.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$143.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$143.68
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cigna of AZ Commercial	$628.60
Rate for Payer: Devoted Health Medicare	$161.64
Rate for Payer: Humana of AZ Medicare	$143.68
Rate for Payer: Seven Corners Travel Insurance	$577.38
Rate for Payer: Southwest Service Administrators UFCW	$610.64
Rate for Payer: TriWest Medicare	$143.68
Rate for Payer: United Healthcare Commercial	$513.66
Rate for Payer: United Healthcare Medicare	$143.68
Rate for Payer: United Healthcare New Mexico Commercial	$170.62
Rate for Payer: Veterans Affairs TRICARE	$142.24

PHALANGECTOMY TOE EACH TOE

Facility

OP

$1,365.00

Service Code	CPT 28150
Hospital Charge Code	24043335
Hospital Revenue Code	360
Min. Negotiated Rate	$134.24
Max. Negotiated Rate	$5,062.66
Rate for Payer: Aetna of AZ Commercial	$1,228.50
Rate for Payer: Arizona Complete Health Allwell	$218.40
Rate for Payer: Banner UC Health Medicare	$1,062.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$928.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$134.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$218.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$218.40
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cigna of AZ Commercial	$682.50
Rate for Payer: Devoted Health Medicare	$245.70
Rate for Payer: Humana of AZ Medicare	$218.40
Rate for Payer: Mercy Care Medicaid	$134.24
Rate for Payer: NaphCare Correctional Healthcare	$1,062.88
Rate for Payer: Seven Corners Travel Insurance	$5,062.66
Rate for Payer: Southwest Service Administrators UFCW	$928.20
Rate for Payer: TriWest Medicare	$218.40
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$218.40
Rate for Payer: Veterans Affairs TRICARE	$216.22

PHALANGECTOMY TOE EACH TOE

Facility

IP

$1,365.00

Service Code	CPT 28150
Hospital Charge Code	24043335
Hospital Revenue Code	360
Min. Negotiated Rate	$1,228.50
Max. Negotiated Rate	$1,228.50
Rate for Payer: Aetna of AZ Commercial	$1,228.50
Rate for Payer: Cash Price	$1,092.00

phenazopyridine 200 mg Tab[CQCH]

Facility

OP

$0.34

Service Code	NDC 65162068210
Hospital Charge Code	219324821
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Arizona Complete Health Allwell	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.23
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.05
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.05
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.22
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Southwest Service Administrators UFCW	$0.23
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: United Healthcare Commercial	$0.19
Rate for Payer: United Healthcare Medicare	$0.05
Rate for Payer: Veterans Affairs TRICARE	$0.05

phenazopyridine 200 mg Tab[CQCH]

Facility

IP

$0.34

Service Code	NDC 65162068210
Hospital Charge Code	219324821
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Aetna of AZ Commercial	$0.31
Rate for Payer: Cash Price	$0.27

PHENobarbital 130 mg/1 mL Inj Sol [CQCH]

Facility

OP

$50.21

Service Code	HCPCS J2560
Hospital Charge Code	105936151
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$45.19
Rate for Payer: Aetna of AZ Commercial	$45.19
Rate for Payer: Arizona Complete Health Allwell	$8.03
Rate for Payer: Banner UC Health Medicare	$8.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$34.14
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$8.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$8.03
Rate for Payer: Cash Price	$40.17
Rate for Payer: Cigna of AZ Commercial	$32.64
Rate for Payer: Devoted Health Medicare	$9.04
Rate for Payer: Humana of AZ Medicare	$8.03
Rate for Payer: Southwest Service Administrators UFCW	$34.14
Rate for Payer: TriWest Medicare	$8.03
Rate for Payer: United Healthcare Commercial	$28.72
Rate for Payer: United Healthcare Medicare	$8.03
Rate for Payer: Veterans Affairs TRICARE	$7.95

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