Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$4,204.19

Service Code	APR-DRG 5643
Hospital Charge Code	APRDRG5642
Min. Negotiated Rate	$4,204.19
Max. Negotiated Rate	$4,204.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,204.19
Rate for Payer: Mercy Care Medicaid	$4,204.19
Rate for Payer: NaphCare Correctional Healthcare	$4,204.19

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$10,044.05

Service Code	APR-DRG 5644
Hospital Charge Code	APRDRG5643
Min. Negotiated Rate	$10,044.05
Max. Negotiated Rate	$10,044.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,044.05
Rate for Payer: Mercy Care Medicaid	$10,044.05
Rate for Payer: NaphCare Correctional Healthcare	$10,044.05

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$2,687.76

Service Code	APR-DRG 5642
Hospital Charge Code	APRDRG5644
Min. Negotiated Rate	$2,687.76
Max. Negotiated Rate	$2,687.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,687.76
Rate for Payer: Mercy Care Medicaid	$2,687.76
Rate for Payer: NaphCare Correctional Healthcare	$2,687.76

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$2,025.64

Service Code	APR-DRG 5641
Hospital Charge Code	APRDRG5642
Min. Negotiated Rate	$2,025.64
Max. Negotiated Rate	$2,025.64
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,025.64
Rate for Payer: Mercy Care Medicaid	$2,025.64
Rate for Payer: NaphCare Correctional Healthcare	$2,025.64

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$2,687.76

Service Code	APR-DRG 5642
Hospital Charge Code	APRDRG5642
Min. Negotiated Rate	$2,687.76
Max. Negotiated Rate	$2,687.76
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,687.76
Rate for Payer: Mercy Care Medicaid	$2,687.76
Rate for Payer: NaphCare Correctional Healthcare	$2,687.76

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$10,044.05

Service Code	APR-DRG 5644
Hospital Charge Code	APRDRG5642
Min. Negotiated Rate	$10,044.05
Max. Negotiated Rate	$10,044.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,044.05
Rate for Payer: Mercy Care Medicaid	$10,044.05
Rate for Payer: NaphCare Correctional Healthcare	$10,044.05

Abortion Without D&C, Aspiration Curettage Or Hysterotomy

Facility

IP

$4,204.19

Service Code	APR-DRG 5643
Hospital Charge Code	APRDRG5644
Min. Negotiated Rate	$4,204.19
Max. Negotiated Rate	$4,204.19
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,204.19
Rate for Payer: Mercy Care Medicaid	$4,204.19
Rate for Payer: NaphCare Correctional Healthcare	$4,204.19

ABSORBTACK 5MM

Facility

IP

$1,451.00

Hospital Charge Code	22528831
Hospital Revenue Code	272
Min. Negotiated Rate	$1,305.90
Max. Negotiated Rate	$1,305.90
Rate for Payer: Aetna of AZ Commercial	$1,305.90
Rate for Payer: Cash Price	$1,160.80

ABSORBTACK 5MM

Facility

OP

$1,451.00

Hospital Charge Code	22528831
Hospital Revenue Code	272
Min. Negotiated Rate	$229.84
Max. Negotiated Rate	$1,305.90
Rate for Payer: Aetna of AZ Commercial	$1,305.90
Rate for Payer: Arizona Complete Health Allwell	$232.16
Rate for Payer: Banner UC Health Medicare	$232.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$986.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$232.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$232.16
Rate for Payer: Cash Price	$1,160.80
Rate for Payer: Cigna of AZ Commercial	$1,015.70
Rate for Payer: Devoted Health Medicare	$261.18
Rate for Payer: Humana of AZ Medicare	$232.16
Rate for Payer: Southwest Service Administrators UFCW	$986.68
Rate for Payer: TriWest Medicare	$232.16
Rate for Payer: United Healthcare Commercial	$829.97
Rate for Payer: United Healthcare Medicare	$232.16
Rate for Payer: Veterans Affairs TRICARE	$229.84

ACCESSPLUS HEMOSTASIS VALVE

Facility

OP

$57.36

Hospital Charge Code	27748827
Hospital Revenue Code	270
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$51.62
Rate for Payer: Aetna of AZ Commercial	$51.62
Rate for Payer: Arizona Complete Health Allwell	$9.18
Rate for Payer: Banner UC Health Medicare	$9.18
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$39.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.18
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.18
Rate for Payer: Cash Price	$45.89
Rate for Payer: Cigna of AZ Commercial	$40.15
Rate for Payer: Devoted Health Medicare	$10.32
Rate for Payer: Humana of AZ Medicare	$9.18
Rate for Payer: Southwest Service Administrators UFCW	$39.00
Rate for Payer: TriWest Medicare	$9.18
Rate for Payer: United Healthcare Commercial	$32.81
Rate for Payer: United Healthcare Medicare	$9.18
Rate for Payer: Veterans Affairs TRICARE	$9.09

ACCESSPLUS HEMOSTASIS VALVE

Facility

IP

$57.36

Hospital Charge Code	27748827
Hospital Revenue Code	270
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$51.62
Rate for Payer: Aetna of AZ Commercial	$51.62
Rate for Payer: Cash Price	$45.89

ACCESS SHEATH FORTE SET B7017

Facility

OP

$345.00

Hospital Charge Code	22354866
Hospital Revenue Code	270
Min. Negotiated Rate	$54.65
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Arizona Complete Health Allwell	$55.20
Rate for Payer: Banner UC Health Medicare	$55.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$234.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$55.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$55.20
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cigna of AZ Commercial	$241.50
Rate for Payer: Devoted Health Medicare	$62.10
Rate for Payer: Humana of AZ Medicare	$55.20
Rate for Payer: Southwest Service Administrators UFCW	$234.60
Rate for Payer: TriWest Medicare	$55.20
Rate for Payer: United Healthcare Commercial	$197.34
Rate for Payer: United Healthcare Medicare	$55.20
Rate for Payer: Veterans Affairs TRICARE	$54.65

ACCESS SHEATH FORTE SET B7017

Facility

IP

$345.00

Hospital Charge Code	22354866
Hospital Revenue Code	270
Min. Negotiated Rate	$310.50
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna of AZ Commercial	$310.50
Rate for Payer: Cash Price	$276.00

acetaminophen 1000 mg/100 mL IV Sol [CQCH]

Facility

OP

$0.44

Service Code	HCPCS J0131
Hospital Charge Code	105907606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Arizona Complete Health Allwell	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.30
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.07
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.07
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Southwest Service Administrators UFCW	$0.30
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: United Healthcare Commercial	$0.25
Rate for Payer: United Healthcare Medicare	$0.07
Rate for Payer: Veterans Affairs TRICARE	$0.07

acetaminophen 1000 mg/100 mL IV Sol [CQCH]

Facility

IP

$0.44

Service Code	HCPCS J0131
Hospital Charge Code	105907606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Cash Price	$0.35

acetaminophen 120 mg Supp [CQCH]

Facility

OP

$0.13

Service Code	NDC 713011812
Hospital Charge Code	105908025
Hospital Revenue Code	257
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Arizona Complete Health Allwell	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.02
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.02
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Southwest Service Administrators UFCW	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: United Healthcare Commercial	$0.07
Rate for Payer: United Healthcare Medicare	$0.02
Rate for Payer: Veterans Affairs TRICARE	$0.02

acetaminophen 120 mg Supp [CQCH]

Facility

IP

$0.13

Service Code	NDC 713011812
Hospital Charge Code	105908025
Hospital Revenue Code	257
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Cash Price	$0.10

acetaminophen 325 mg/10.15 mL Susp UD[CQCH]

Facility

IP

$0.17

Service Code	NDC 68094033062
Hospital Charge Code	177137384
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Cash Price	$0.14

acetaminophen 325 mg/10.15 mL Susp UD[CQCH]

Facility

OP

$0.17

Service Code	NDC 68094033062
Hospital Charge Code	177137384
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna of AZ Commercial	$0.15
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of AZ Commercial	$0.11
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.12
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

acetaminophen 325 mg Supp [CQCH]

Facility

IP

$0.22

Service Code	NDC 713016412
Hospital Charge Code	105907880
Hospital Revenue Code	257
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Cash Price	$0.18

acetaminophen 325 mg Supp [CQCH]

Facility

OP

$0.22

Service Code	NDC 713016412
Hospital Charge Code	105907880
Hospital Revenue Code	257
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.15
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.13
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.03

acetaminophen 325 mg Tab [CQCH]

Facility

IP

$0.01

Service Code	NDC 50580060002
Hospital Charge Code	105907813
Hospital Revenue Code	257
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Cash Price	$0.01

acetaminophen 325 mg Tab [CQCH]

Facility

OP

$0.01

Service Code	NDC 50580060002
Hospital Charge Code	105907813
Hospital Revenue Code	257
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

acetaminophen 500 mg Tab [CQCH]

Facility

IP

$0.02

Service Code	NDC 50580041202
Hospital Charge Code	105907746
Hospital Revenue Code	257
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Cash Price	$0.02

acetaminophen 500 mg Tab [CQCH]

Facility

OP

$0.02

Service Code	NDC 50580041202
Hospital Charge Code	105907746
Hospital Revenue Code	257
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Arizona Complete Health Allwell	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.00
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Devoted Health Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Southwest Service Administrators UFCW	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare	$0.00
Rate for Payer: Veterans Affairs TRICARE	$0.00

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