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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CONCENTRATION INFECT AGENT

Facility

IP

$81.00

Service Code	CPT 87015
Hospital Charge Code	22422557
Hospital Revenue Code	306
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of AZ Commercial	$72.90
Rate for Payer: Bisbee Police All Plans	$21.06
Rate for Payer: Cash Price	$64.80
Rate for Payer: Self Pay Self Pay	$64.80

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0574
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: AHCCCS Medicaid	$6,008.19
Rate for Payer: Allwell Medicaid	$6,008.19
Rate for Payer: AZCH Complete Medicaid	$6,008.19
Rate for Payer: Banner UC Health Medicaid	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$8,392.25

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG0573
Min. Negotiated Rate	$8,392.25
Max. Negotiated Rate	$8,392.25
Rate for Payer: AHCCCS Medicaid	$8,392.25
Rate for Payer: Allwell Medicaid	$8,392.25
Rate for Payer: AZCH Complete Medicaid	$8,392.25
Rate for Payer: Banner UC Health Medicaid	$8,392.25
Rate for Payer: Mercy Care Medicaid	$8,392.25

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0573
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: AHCCCS Medicaid	$6,008.19
Rate for Payer: Allwell Medicaid	$6,008.19
Rate for Payer: AZCH Complete Medicaid	$6,008.19
Rate for Payer: Banner UC Health Medicaid	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$8,392.25

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$8,392.25
Max. Negotiated Rate	$8,392.25
Rate for Payer: AHCCCS Medicaid	$8,392.25
Rate for Payer: Allwell Medicaid	$8,392.25
Rate for Payer: AZCH Complete Medicaid	$8,392.25
Rate for Payer: Banner UC Health Medicaid	$8,392.25
Rate for Payer: Mercy Care Medicaid	$8,392.25

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$16,195.33

Service Code	APR-DRG 0574
Hospital Charge Code	APRDRG0574
Min. Negotiated Rate	$16,195.33
Max. Negotiated Rate	$16,195.33
Rate for Payer: AHCCCS Medicaid	$16,195.33
Rate for Payer: Allwell Medicaid	$16,195.33
Rate for Payer: AZCH Complete Medicaid	$16,195.33
Rate for Payer: Banner UC Health Medicaid	$16,195.33
Rate for Payer: Mercy Care Medicaid	$16,195.33

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$8,392.25

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG0574
Min. Negotiated Rate	$8,392.25
Max. Negotiated Rate	$8,392.25
Rate for Payer: AHCCCS Medicaid	$8,392.25
Rate for Payer: Allwell Medicaid	$8,392.25
Rate for Payer: AZCH Complete Medicaid	$8,392.25
Rate for Payer: Banner UC Health Medicaid	$8,392.25
Rate for Payer: Mercy Care Medicaid	$8,392.25

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: AHCCCS Medicaid	$6,008.19
Rate for Payer: Allwell Medicaid	$6,008.19
Rate for Payer: AZCH Complete Medicaid	$6,008.19
Rate for Payer: Banner UC Health Medicaid	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$16,195.33

Service Code	APR-DRG 0574
Hospital Charge Code	APRDRG0571
Min. Negotiated Rate	$16,195.33
Max. Negotiated Rate	$16,195.33
Rate for Payer: AHCCCS Medicaid	$16,195.33
Rate for Payer: Allwell Medicaid	$16,195.33
Rate for Payer: AZCH Complete Medicaid	$16,195.33
Rate for Payer: Banner UC Health Medicaid	$16,195.33
Rate for Payer: Mercy Care Medicaid	$16,195.33

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$8,392.25

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG0571
Min. Negotiated Rate	$8,392.25
Max. Negotiated Rate	$8,392.25
Rate for Payer: AHCCCS Medicaid	$8,392.25
Rate for Payer: Allwell Medicaid	$8,392.25
Rate for Payer: AZCH Complete Medicaid	$8,392.25
Rate for Payer: Banner UC Health Medicaid	$8,392.25
Rate for Payer: Mercy Care Medicaid	$8,392.25

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$4,350.78

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG0574
Min. Negotiated Rate	$4,350.78
Max. Negotiated Rate	$4,350.78
Rate for Payer: AHCCCS Medicaid	$4,350.78
Rate for Payer: Allwell Medicaid	$4,350.78
Rate for Payer: AZCH Complete Medicaid	$4,350.78
Rate for Payer: Banner UC Health Medicaid	$4,350.78
Rate for Payer: Mercy Care Medicaid	$4,350.78

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$4,350.78

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG0573
Min. Negotiated Rate	$4,350.78
Max. Negotiated Rate	$4,350.78
Rate for Payer: AHCCCS Medicaid	$4,350.78
Rate for Payer: Allwell Medicaid	$4,350.78
Rate for Payer: AZCH Complete Medicaid	$4,350.78
Rate for Payer: Banner UC Health Medicaid	$4,350.78
Rate for Payer: Mercy Care Medicaid	$4,350.78

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$4,350.78

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$4,350.78
Max. Negotiated Rate	$4,350.78
Rate for Payer: AHCCCS Medicaid	$4,350.78
Rate for Payer: Allwell Medicaid	$4,350.78
Rate for Payer: AZCH Complete Medicaid	$4,350.78
Rate for Payer: Banner UC Health Medicaid	$4,350.78
Rate for Payer: Mercy Care Medicaid	$4,350.78

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$16,195.33

Service Code	APR-DRG 0574
Hospital Charge Code	APRDRG0573
Min. Negotiated Rate	$16,195.33
Max. Negotiated Rate	$16,195.33
Rate for Payer: AHCCCS Medicaid	$16,195.33
Rate for Payer: Allwell Medicaid	$16,195.33
Rate for Payer: AZCH Complete Medicaid	$16,195.33
Rate for Payer: Banner UC Health Medicaid	$16,195.33
Rate for Payer: Mercy Care Medicaid	$16,195.33

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$4,350.78

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG0571
Min. Negotiated Rate	$4,350.78
Max. Negotiated Rate	$4,350.78
Rate for Payer: AHCCCS Medicaid	$4,350.78
Rate for Payer: Allwell Medicaid	$4,350.78
Rate for Payer: AZCH Complete Medicaid	$4,350.78
Rate for Payer: Banner UC Health Medicaid	$4,350.78
Rate for Payer: Mercy Care Medicaid	$4,350.78

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$16,195.33

Service Code	APR-DRG 0574
Hospital Charge Code	APRDRG0572
Min. Negotiated Rate	$16,195.33
Max. Negotiated Rate	$16,195.33
Rate for Payer: AHCCCS Medicaid	$16,195.33
Rate for Payer: Allwell Medicaid	$16,195.33
Rate for Payer: AZCH Complete Medicaid	$16,195.33
Rate for Payer: Banner UC Health Medicaid	$16,195.33
Rate for Payer: Mercy Care Medicaid	$16,195.33

Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma

Facility

IP

$6,008.19

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG0571
Min. Negotiated Rate	$6,008.19
Max. Negotiated Rate	$6,008.19
Rate for Payer: AHCCCS Medicaid	$6,008.19
Rate for Payer: Allwell Medicaid	$6,008.19
Rate for Payer: AZCH Complete Medicaid	$6,008.19
Rate for Payer: Banner UC Health Medicaid	$6,008.19
Rate for Payer: Mercy Care Medicaid	$6,008.19

CONE TIP URETERAL CATHETER 6FR

Facility

OP

$67.00

Hospital Charge Code	27748907
Hospital Revenue Code	270
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.72
Rate for Payer: Amerigroup Medicare	$10.72
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.72
Rate for Payer: Banner UC Health Medicare	$10.72
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.72
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

CONE TIP URETERAL CATHETER 6FR

Facility

IP

$67.00

Hospital Charge Code	27748907
Hospital Revenue Code	270
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

Confirmation Tests THC

Facility

OP

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090933
Hospital Revenue Code	301
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Aetna of AZ Medicare	$78.96
Rate for Payer: Allwell Medicare	$45.12
Rate for Payer: Amerigroup Medicare	$45.12
Rate for Payer: APIPA Medicare/Medicaid	$105.33
Rate for Payer: AZCH Complete Medicare	$45.12
Rate for Payer: Banner UC Health Medicare	$45.12
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Copperpoint Commercial	$69.80
Rate for Payer: Health Net of AZ Commercial	$169.20
Rate for Payer: Health Net of AZ Medicare	$78.96
Rate for Payer: Humana of AZ Medicare	$45.12
Rate for Payer: Self Pay Self Pay	$225.60
Rate for Payer: TriWest Medicare	$45.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.76

Confirmation Tests THC

Facility

IP

$282.00

Service Code	CPT 80307
Hospital Charge Code	23090933
Hospital Revenue Code	301
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Cash Price	$225.60
Rate for Payer: Self Pay Self Pay	$225.60

conjugated estrogens 0.625 mg/g Vag Crm w/Appl [CQCH]

Facility

OP

$330.90

Service Code	NDC 46087221
Hospital Charge Code	105917457
Hospital Revenue Code	251
Min. Negotiated Rate	$52.94
Max. Negotiated Rate	$297.81
Rate for Payer: Aetna of AZ Commercial	$297.81
Rate for Payer: Aetna of AZ Medicare	$92.65
Rate for Payer: Allwell Medicare	$52.94
Rate for Payer: Amerigroup Medicare	$52.94
Rate for Payer: APIPA Medicare/Medicaid	$123.59
Rate for Payer: AZCH Complete Medicare	$52.94
Rate for Payer: Banner UC Health Medicare	$52.94
Rate for Payer: Bisbee Police All Plans	$86.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.01
Rate for Payer: Cash Price	$264.72
Rate for Payer: Cigna of AZ Commercial	$215.09
Rate for Payer: Copperpoint Commercial	$81.90
Rate for Payer: Health Net of AZ Commercial	$198.54
Rate for Payer: Health Net of AZ Medicare	$92.65
Rate for Payer: Humana of AZ Medicare	$52.94
Rate for Payer: Self Pay Self Pay	$264.72
Rate for Payer: TriWest Medicare	$52.94
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.56

conjugated estrogens 0.625 mg/g Vag Crm w/Appl [CQCH]

Facility

IP

$330.90

Service Code	NDC 46087221
Hospital Charge Code	105917457
Hospital Revenue Code	251
Min. Negotiated Rate	$86.03
Max. Negotiated Rate	$297.81
Rate for Payer: Aetna of AZ Commercial	$297.81
Rate for Payer: Bisbee Police All Plans	$86.03
Rate for Payer: Cash Price	$264.72
Rate for Payer: Self Pay Self Pay	$264.72

conjugated estrogens 0.625 mg Tab [CQCH]

Facility

OP

$3.00

Service Code	NDC 46110281
Hospital Charge Code	105917392
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Aetna of AZ Medicare	$0.84
Rate for Payer: Allwell Medicare	$0.48
Rate for Payer: Amerigroup Medicare	$0.48
Rate for Payer: APIPA Medicare/Medicaid	$1.12
Rate for Payer: AZCH Complete Medicare	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Bisbee Police All Plans	$0.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cigna of AZ Commercial	$1.95
Rate for Payer: Copperpoint Commercial	$0.74
Rate for Payer: Health Net of AZ Commercial	$1.80
Rate for Payer: Health Net of AZ Medicare	$0.84
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Self Pay Self Pay	$2.40
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.54

conjugated estrogens 0.625 mg Tab [CQCH]

Facility

IP

$3.00

Service Code	NDC 46110281
Hospital Charge Code	105917392
Hospital Revenue Code	251
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Bisbee Police All Plans	$0.78
Rate for Payer: Cash Price	$2.40
Rate for Payer: Self Pay Self Pay	$2.40

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