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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CMV Quant DNA PCR (Plasma) LC

Facility

OP

$319.00

Service Code	CPT 87497
Hospital Charge Code	2029097
Hospital Revenue Code	300
Min. Negotiated Rate	$51.04
Max. Negotiated Rate	$287.10
Rate for Payer: Aetna of AZ Commercial	$287.10
Rate for Payer: Aetna of AZ Medicare	$89.32
Rate for Payer: Allwell Medicare	$51.04
Rate for Payer: Amerigroup Medicare	$51.04
Rate for Payer: APIPA Medicare/Medicaid	$119.15
Rate for Payer: AZCH Complete Medicare	$51.04
Rate for Payer: Banner UC Health Medicare	$51.04
Rate for Payer: Bisbee Police All Plans	$82.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.92
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cigna of AZ Commercial	$207.35
Rate for Payer: Copperpoint Commercial	$78.95
Rate for Payer: Health Net of AZ Commercial	$191.40
Rate for Payer: Health Net of AZ Medicare	$89.32
Rate for Payer: Humana of AZ Medicare	$51.04
Rate for Payer: Self Pay Self Pay	$255.20
Rate for Payer: TriWest Medicare	$51.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$185.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.42

CO2 DETECTOR ADULT

Facility

OP

$57.00

Hospital Charge Code	22593124
Hospital Revenue Code	272
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$9.12
Rate for Payer: Amerigroup Medicare	$9.12
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$9.12
Rate for Payer: Banner UC Health Medicare	$9.12
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$9.12
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$9.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

CO2 DETECTOR ADULT

Facility

IP

$57.00

Hospital Charge Code	22593124
Hospital Revenue Code	272
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6613
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: AHCCCS Medicaid	$21,425.67
Rate for Payer: Allwell Medicaid	$21,425.67
Rate for Payer: AZCH Complete Medicaid	$21,425.67
Rate for Payer: Banner UC Health Medicaid	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: AHCCCS Medicaid	$21,425.67
Rate for Payer: Allwell Medicaid	$21,425.67
Rate for Payer: AZCH Complete Medicaid	$21,425.67
Rate for Payer: Banner UC Health Medicaid	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: AHCCCS Medicaid	$21,425.67
Rate for Payer: Allwell Medicaid	$21,425.67
Rate for Payer: AZCH Complete Medicaid	$21,425.67
Rate for Payer: Banner UC Health Medicaid	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6613
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: AHCCCS Medicaid	$10,455.07
Rate for Payer: Allwell Medicaid	$10,455.07
Rate for Payer: AZCH Complete Medicaid	$10,455.07
Rate for Payer: Banner UC Health Medicaid	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: AHCCCS Medicaid	$10,455.07
Rate for Payer: Allwell Medicaid	$10,455.07
Rate for Payer: AZCH Complete Medicaid	$10,455.07
Rate for Payer: Banner UC Health Medicaid	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: AHCCCS Medicaid	$5,502.48
Rate for Payer: Allwell Medicaid	$5,502.48
Rate for Payer: AZCH Complete Medicaid	$5,502.48
Rate for Payer: Banner UC Health Medicaid	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: AHCCCS Medicaid	$21,425.67
Rate for Payer: Allwell Medicaid	$21,425.67
Rate for Payer: AZCH Complete Medicaid	$21,425.67
Rate for Payer: Banner UC Health Medicaid	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: AHCCCS Medicaid	$7,162.00
Rate for Payer: Allwell Medicaid	$7,162.00
Rate for Payer: AZCH Complete Medicaid	$7,162.00
Rate for Payer: Banner UC Health Medicaid	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6613
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: AHCCCS Medicaid	$5,502.48
Rate for Payer: Allwell Medicaid	$5,502.48
Rate for Payer: AZCH Complete Medicaid	$5,502.48
Rate for Payer: Banner UC Health Medicaid	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: AHCCCS Medicaid	$10,455.07
Rate for Payer: Allwell Medicaid	$10,455.07
Rate for Payer: AZCH Complete Medicaid	$10,455.07
Rate for Payer: Banner UC Health Medicaid	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: AHCCCS Medicaid	$7,162.00
Rate for Payer: Allwell Medicaid	$7,162.00
Rate for Payer: AZCH Complete Medicaid	$7,162.00
Rate for Payer: Banner UC Health Medicaid	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: AHCCCS Medicaid	$7,162.00
Rate for Payer: Allwell Medicaid	$7,162.00
Rate for Payer: AZCH Complete Medicaid	$7,162.00
Rate for Payer: Banner UC Health Medicaid	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6613
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: AHCCCS Medicaid	$7,162.00
Rate for Payer: Allwell Medicaid	$7,162.00
Rate for Payer: AZCH Complete Medicaid	$7,162.00
Rate for Payer: Banner UC Health Medicaid	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: AHCCCS Medicaid	$10,455.07
Rate for Payer: Allwell Medicaid	$10,455.07
Rate for Payer: AZCH Complete Medicaid	$10,455.07
Rate for Payer: Banner UC Health Medicaid	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: AHCCCS Medicaid	$5,502.48
Rate for Payer: Allwell Medicaid	$5,502.48
Rate for Payer: AZCH Complete Medicaid	$5,502.48
Rate for Payer: Banner UC Health Medicaid	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: AHCCCS Medicaid	$5,502.48
Rate for Payer: Allwell Medicaid	$5,502.48
Rate for Payer: AZCH Complete Medicaid	$5,502.48
Rate for Payer: Banner UC Health Medicaid	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48

coagulation factor IX recombinant Kit[CQCH]

Facility

OP

$3,060.00

Service Code	HCPCS J7195
Hospital Charge Code	244006072
Hospital Revenue Code	250
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$2,754.00
Rate for Payer: Aetna of AZ Commercial	$2,754.00
Rate for Payer: Aetna of AZ Medicare	$856.80
Rate for Payer: Allwell Medicare	$489.60
Rate for Payer: Amerigroup Medicare	$489.60
Rate for Payer: APIPA Medicare/Medicaid	$1,142.91
Rate for Payer: AZCH Complete Medicare	$489.60
Rate for Payer: Banner UC Health Medicare	$489.60
Rate for Payer: Bisbee Police All Plans	$795.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,080.80
Rate for Payer: Cash Price	$2,448.00
Rate for Payer: Cigna of AZ Commercial	$1,989.00
Rate for Payer: Copperpoint Commercial	$757.35
Rate for Payer: Health Net of AZ Commercial	$1,836.00
Rate for Payer: Health Net of AZ Medicare	$856.80
Rate for Payer: Humana of AZ Medicare	$489.60
Rate for Payer: Self Pay Self Pay	$2,448.00
Rate for Payer: TriWest Medicare	$489.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,783.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$550.80

coagulation factor IX recombinant Kit[CQCH]

Facility

IP

$3,060.00

Service Code	HCPCS J7195
Hospital Charge Code	244006072
Hospital Revenue Code	250
Min. Negotiated Rate	$795.60
Max. Negotiated Rate	$2,754.00
Rate for Payer: Aetna of AZ Commercial	$2,754.00
Rate for Payer: Bisbee Police All Plans	$795.60
Rate for Payer: Cash Price	$2,448.00
Rate for Payer: Self Pay Self Pay	$2,448.00

.Cobalt, Comment LC

Facility

IP

$268.00

Service Code	CPT 83018
Hospital Charge Code	22311139
Hospital Revenue Code	302
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Cash Price	$214.40
Rate for Payer: Self Pay Self Pay	$214.40

.Cobalt, Comment LC

Facility

OP

$268.00

Service Code	CPT 83018
Hospital Charge Code	22311139
Hospital Revenue Code	302
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Aetna of AZ Medicare	$75.04
Rate for Payer: Allwell Medicare	$42.88
Rate for Payer: Amerigroup Medicare	$42.88
Rate for Payer: APIPA Medicare/Medicaid	$100.10
Rate for Payer: AZCH Complete Medicare	$42.88
Rate for Payer: Banner UC Health Medicare	$42.88
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$182.24
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$174.20
Rate for Payer: Copperpoint Commercial	$66.33
Rate for Payer: Health Net of AZ Commercial	$160.80
Rate for Payer: Health Net of AZ Medicare	$75.04
Rate for Payer: Humana of AZ Medicare	$42.88
Rate for Payer: Self Pay Self Pay	$214.40
Rate for Payer: TriWest Medicare	$42.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$156.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.24

Cobalt LC

Facility

OP

$255.00

Service Code	CPT 83018
Hospital Charge Code	6738683
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Aetna of AZ Medicare	$71.40
Rate for Payer: Allwell Medicare	$40.80
Rate for Payer: Amerigroup Medicare	$40.80
Rate for Payer: APIPA Medicare/Medicaid	$95.24
Rate for Payer: AZCH Complete Medicare	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$173.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Copperpoint Commercial	$63.11
Rate for Payer: Health Net of AZ Commercial	$153.00
Rate for Payer: Health Net of AZ Medicare	$71.40
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Self Pay Self Pay	$204.00
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.90

Cobalt LC

Facility

IP

$255.00

Service Code	CPT 83018
Hospital Charge Code	6738683
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Cash Price	$204.00
Rate for Payer: Self Pay Self Pay	$204.00

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