Price and Financial Assistance Policy



The chart below has been developed to give patients an estimate of care prices for our most common procedures. 

Direct Pay Self Pay Discount Policy for Uninsured/Underinsured (09004 S)

Direct Pay Self Pay Price Sliding Fee Schedule


Maricopa Medical Center - Updated 10/2014
[download Prices file in Excel]
Prices for Key Procedures
Revised 10/20/2014 Direct Pay SELF PAY Price
    default to Medicare rates||>200% FPL
Code Description Price for Uninsured Patient
Inpatient APR-DRG
5601 & 6401 Vaginal Delivery  - DRG 775  Maricopa Cty Resident - $5456
  Normal Newborn - DRG 795 incl w/delivery
5401 & 6401 Cesarean Delivery  - DRG 765 Maricopa Cty Resident - $6614
   Normal Newborn - DRG 795  incl w/delivery
  Vaginal Delivery - DRG 775 Non Resident - $6500
   Normal Newborn - DRG 795  incl w/delivery
  Cesarean Delivery  - DRG 765  Non Resident - $7700
1392 Pneumonia - Moderate - DRG 194 $11,029.34
1943 Heart Failure- Major- DRG 291 $16,512.11
1403 Chronic Obstructive Plumonary Disorder - DRG 192 $7,789.62
4632 Kidney/Urinary Tract Infection - Moderate - DRG 690 $8,657.58
2632 Lap Cholecystectomy- Moderate - DRG 418 $18,601.15
2251 Appendectomy- Minor - DRG 343 $10,546.41
MS-DRG
192 192 Chronic Obstructive Pulmonary Disease without CC/MCC $7,789.62
194 194 Simple Pneumonia and Pleurisy with CC $11,029.34
291 291 Heart Failure and Shock with MCC $16,512.10
343 343 Appendectomy without Complicated Principal Diagnosis without CC/MCC $10,546.41
418 418 Laparoscopic Cholecystectomy without C.D.E. with CC $18,601.15
488 488 Knee Procedures without Principal Diagnosis of Infection with CC/MCC $18,903.67
690 690 Kidney and Urinary Tract Infections without MCC $8,657.58
765 765 Cesarean Section with CC/MCC $5,600.00
775 775 Vaginal Delivery without Complicating Diagnoses $3,850.00
795 795 Normal Newborn incl w/delivery
Outpatient CPT4 
99283 Emergency Department Visit - Level 3 $136.03
99203/99213 Urgent Care Visit - Level 3 $95.12
69421 Ear Tubes (Myringotomy) HCPC 69420,69421 $1,180.62
42825 Tonsillectomy 12yrs under HCPC 42825  $1,742.64
42826 Tonsillectomy 12 and over HCPC 42826 $1,742.64
93451 Heart Catheter left HCPC 93452 Right HCPC 93451 $2,718.42
45378 Colonoscopy diagnostic HPCPC 45378 $655.31
97001 Physical Therapy Evaluation HCPC 97001 $114.57
70460 MRI- Head/Skull w/ contrst HCPC 70460   $300.49
70450 MRI- Head/Skull w/o Contrst 70450 $191.89
70470 MRI- Head/Skull w/o followed by with HCPC 70470 $334.09
77080 Bone Density Exam HCPC 77080 $71.48
77057 Mammogram (screening bilateral) HCPC 77057 $94.81
66984/66982 Cataract removal - Extracapsular with insertion of lens prothesis  (1 stage) 66984/66982 complex $1,670.41
47652 Laporoscopic Cholecystectomy-Total 47562 $3,358.35
64721 Carpal Tunnel Release 64721 $1,321.02
     

Maternity Package pricing limited to residents of Maricopa County
Individuals residing outside of Maricopa will be billed at Medicare rates

MIHS MATERNITY PACKAGE PLAN AGREEMENT - Resident Package

MIHS MATERNITY PACKAGE PLAN AGREEMENT - Non Resident Package