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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Culdoplasty Enterocele Repair abdominal

Facility

OP

$4,215.00

Service Code	CPT 57270
Hospital Charge Code	27267814
Hospital Revenue Code	360
Min. Negotiated Rate	$674.40
Max. Negotiated Rate	$3,793.50
Rate for Payer: Aetna of AZ Commercial	$3,793.50
Rate for Payer: Aetna of AZ Medicare	$1,180.20
Rate for Payer: Allwell Medicare	$674.40
Rate for Payer: Amerigroup Medicare	$674.40
Rate for Payer: APIPA Medicare/Medicaid	$1,574.30
Rate for Payer: AZCH Complete Medicare	$674.40
Rate for Payer: Banner UC Health Medicare	$674.40
Rate for Payer: Bisbee Police All Plans	$1,095.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,866.20
Rate for Payer: Cash Price	$3,372.00
Rate for Payer: Cash Price	$3,372.00
Rate for Payer: Cigna of AZ Commercial	$2,107.50
Rate for Payer: Copperpoint Commercial	$1,043.21
Rate for Payer: Health Net of AZ Commercial	$2,529.00
Rate for Payer: Health Net of AZ Medicare	$1,180.20
Rate for Payer: Humana of AZ Medicare	$674.40
Rate for Payer: Self Pay Self Pay	$3,372.00
Rate for Payer: TriWest Medicare	$674.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$758.70

Cva And Precerebral Occlusion With Infarction

Facility

IP

$4,900.68

Service Code	APR-DRG 0451
Hospital Charge Code	APRDRG0451
Min. Negotiated Rate	$4,900.68
Max. Negotiated Rate	$4,900.68
Rate for Payer: AHCCCS Medicaid	$4,900.68
Rate for Payer: Allwell Medicaid	$4,900.68
Rate for Payer: AZCH Complete Medicaid	$4,900.68
Rate for Payer: Banner UC Health Medicaid	$4,900.68
Rate for Payer: Mercy Care Medicaid	$4,900.68

Cva And Precerebral Occlusion With Infarction

Facility

IP

$16,038.21

Service Code	APR-DRG 0454
Hospital Charge Code	APRDRG0454
Min. Negotiated Rate	$16,038.21
Max. Negotiated Rate	$16,038.21
Rate for Payer: AHCCCS Medicaid	$16,038.21
Rate for Payer: Allwell Medicaid	$16,038.21
Rate for Payer: AZCH Complete Medicaid	$16,038.21
Rate for Payer: Banner UC Health Medicaid	$16,038.21
Rate for Payer: Mercy Care Medicaid	$16,038.21

Cva And Precerebral Occlusion With Infarction

Facility

IP

$16,038.21

Service Code	APR-DRG 0454
Hospital Charge Code	APRDRG0453
Min. Negotiated Rate	$16,038.21
Max. Negotiated Rate	$16,038.21
Rate for Payer: AHCCCS Medicaid	$16,038.21
Rate for Payer: Allwell Medicaid	$16,038.21
Rate for Payer: AZCH Complete Medicaid	$16,038.21
Rate for Payer: Banner UC Health Medicaid	$16,038.21
Rate for Payer: Mercy Care Medicaid	$16,038.21

Cva And Precerebral Occlusion With Infarction

Facility

IP

$4,900.68

Service Code	APR-DRG 0451
Hospital Charge Code	APRDRG0454
Min. Negotiated Rate	$4,900.68
Max. Negotiated Rate	$4,900.68
Rate for Payer: AHCCCS Medicaid	$4,900.68
Rate for Payer: Allwell Medicaid	$4,900.68
Rate for Payer: AZCH Complete Medicaid	$4,900.68
Rate for Payer: Banner UC Health Medicaid	$4,900.68
Rate for Payer: Mercy Care Medicaid	$4,900.68

Cva And Precerebral Occlusion With Infarction

Facility

IP

$6,159.69

Service Code	APR-DRG 0452
Hospital Charge Code	APRDRG0454
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Cva And Precerebral Occlusion With Infarction

Facility

IP

$6,159.69

Service Code	APR-DRG 0452
Hospital Charge Code	APRDRG0451
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Cva And Precerebral Occlusion With Infarction

Facility

IP

$6,159.69

Service Code	APR-DRG 0452
Hospital Charge Code	APRDRG0452
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Cva And Precerebral Occlusion With Infarction

Facility

IP

$8,899.36

Service Code	APR-DRG 0453
Hospital Charge Code	APRDRG0453
Min. Negotiated Rate	$8,899.36
Max. Negotiated Rate	$8,899.36
Rate for Payer: AHCCCS Medicaid	$8,899.36
Rate for Payer: Allwell Medicaid	$8,899.36
Rate for Payer: AZCH Complete Medicaid	$8,899.36
Rate for Payer: Banner UC Health Medicaid	$8,899.36
Rate for Payer: Mercy Care Medicaid	$8,899.36

Cva And Precerebral Occlusion With Infarction

Facility

IP

$8,899.36

Service Code	APR-DRG 0453
Hospital Charge Code	APRDRG0454
Min. Negotiated Rate	$8,899.36
Max. Negotiated Rate	$8,899.36
Rate for Payer: AHCCCS Medicaid	$8,899.36
Rate for Payer: Allwell Medicaid	$8,899.36
Rate for Payer: AZCH Complete Medicaid	$8,899.36
Rate for Payer: Banner UC Health Medicaid	$8,899.36
Rate for Payer: Mercy Care Medicaid	$8,899.36

Cva And Precerebral Occlusion With Infarction

Facility

IP

$4,900.68

Service Code	APR-DRG 0451
Hospital Charge Code	APRDRG0453
Min. Negotiated Rate	$4,900.68
Max. Negotiated Rate	$4,900.68
Rate for Payer: AHCCCS Medicaid	$4,900.68
Rate for Payer: Allwell Medicaid	$4,900.68
Rate for Payer: AZCH Complete Medicaid	$4,900.68
Rate for Payer: Banner UC Health Medicaid	$4,900.68
Rate for Payer: Mercy Care Medicaid	$4,900.68

Cva And Precerebral Occlusion With Infarction

Facility

IP

$8,899.36

Service Code	APR-DRG 0453
Hospital Charge Code	APRDRG0451
Min. Negotiated Rate	$8,899.36
Max. Negotiated Rate	$8,899.36
Rate for Payer: AHCCCS Medicaid	$8,899.36
Rate for Payer: Allwell Medicaid	$8,899.36
Rate for Payer: AZCH Complete Medicaid	$8,899.36
Rate for Payer: Banner UC Health Medicaid	$8,899.36
Rate for Payer: Mercy Care Medicaid	$8,899.36

Cva And Precerebral Occlusion With Infarction

Facility

IP

$16,038.21

Service Code	APR-DRG 0454
Hospital Charge Code	APRDRG0451
Min. Negotiated Rate	$16,038.21
Max. Negotiated Rate	$16,038.21
Rate for Payer: AHCCCS Medicaid	$16,038.21
Rate for Payer: Allwell Medicaid	$16,038.21
Rate for Payer: AZCH Complete Medicaid	$16,038.21
Rate for Payer: Banner UC Health Medicaid	$16,038.21
Rate for Payer: Mercy Care Medicaid	$16,038.21

Cva And Precerebral Occlusion With Infarction

Facility

IP

$6,159.69

Service Code	APR-DRG 0452
Hospital Charge Code	APRDRG0453
Min. Negotiated Rate	$6,159.69
Max. Negotiated Rate	$6,159.69
Rate for Payer: AHCCCS Medicaid	$6,159.69
Rate for Payer: Allwell Medicaid	$6,159.69
Rate for Payer: AZCH Complete Medicaid	$6,159.69
Rate for Payer: Banner UC Health Medicaid	$6,159.69
Rate for Payer: Mercy Care Medicaid	$6,159.69

Cva And Precerebral Occlusion With Infarction

Facility

IP

$16,038.21

Service Code	APR-DRG 0454
Hospital Charge Code	APRDRG0452
Min. Negotiated Rate	$16,038.21
Max. Negotiated Rate	$16,038.21
Rate for Payer: AHCCCS Medicaid	$16,038.21
Rate for Payer: Allwell Medicaid	$16,038.21
Rate for Payer: AZCH Complete Medicaid	$16,038.21
Rate for Payer: Banner UC Health Medicaid	$16,038.21
Rate for Payer: Mercy Care Medicaid	$16,038.21

Cva And Precerebral Occlusion With Infarction

Facility

IP

$4,900.68

Service Code	APR-DRG 0451
Hospital Charge Code	APRDRG0452
Min. Negotiated Rate	$4,900.68
Max. Negotiated Rate	$4,900.68
Rate for Payer: AHCCCS Medicaid	$4,900.68
Rate for Payer: Allwell Medicaid	$4,900.68
Rate for Payer: AZCH Complete Medicaid	$4,900.68
Rate for Payer: Banner UC Health Medicaid	$4,900.68
Rate for Payer: Mercy Care Medicaid	$4,900.68

Cva And Precerebral Occlusion With Infarction

Facility

IP

$8,899.36

Service Code	APR-DRG 0453
Hospital Charge Code	APRDRG0452
Min. Negotiated Rate	$8,899.36
Max. Negotiated Rate	$8,899.36
Rate for Payer: AHCCCS Medicaid	$8,899.36
Rate for Payer: Allwell Medicaid	$8,899.36
Rate for Payer: AZCH Complete Medicaid	$8,899.36
Rate for Payer: Banner UC Health Medicaid	$8,899.36
Rate for Payer: Mercy Care Medicaid	$8,899.36

cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]

Facility

IP

$2.13

Service Code	HCPCS J3420
Hospital Charge Code	105917587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Cash Price	$1.70
Rate for Payer: Self Pay Self Pay	$1.70

cyanocobalamin 1000 mcg/mL Inj Sol [CQCH]

Facility

OP

$2.13

Service Code	HCPCS J3420
Hospital Charge Code	105917587
Hospital Revenue Code	251
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.92
Rate for Payer: Aetna of AZ Commercial	$1.92
Rate for Payer: Aetna of AZ Medicare	$0.60
Rate for Payer: Allwell Medicare	$0.34
Rate for Payer: Amerigroup Medicare	$0.34
Rate for Payer: APIPA Medicare/Medicaid	$0.80
Rate for Payer: AZCH Complete Medicare	$0.34
Rate for Payer: Banner UC Health Medicare	$0.34
Rate for Payer: Bisbee Police All Plans	$0.55
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.45
Rate for Payer: Cash Price	$1.70
Rate for Payer: Cigna of AZ Commercial	$1.38
Rate for Payer: Copperpoint Commercial	$0.53
Rate for Payer: Health Net of AZ Commercial	$1.28
Rate for Payer: Health Net of AZ Medicare	$0.60
Rate for Payer: Humana of AZ Medicare	$0.34
Rate for Payer: Self Pay Self Pay	$1.70
Rate for Payer: TriWest Medicare	$0.34
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.38

cyclopentolate Ophth 1% Sol [CQCH]

Facility

OP

$26.01

Service Code	NDC 17478010002
Hospital Charge Code	105917736
Hospital Revenue Code	251
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna of AZ Commercial	$23.41
Rate for Payer: Aetna of AZ Medicare	$7.28
Rate for Payer: Allwell Medicare	$4.16
Rate for Payer: Amerigroup Medicare	$4.16
Rate for Payer: APIPA Medicare/Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$17.69
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cigna of AZ Commercial	$16.91
Rate for Payer: Copperpoint Commercial	$6.44
Rate for Payer: Health Net of AZ Commercial	$15.61
Rate for Payer: Health Net of AZ Medicare	$7.28
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Self Pay Self Pay	$20.81
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.68

cyclopentolate Ophth 1% Sol [CQCH]

Facility

IP

$26.01

Service Code	NDC 17478010002
Hospital Charge Code	105917736
Hospital Revenue Code	251
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna of AZ Commercial	$23.41
Rate for Payer: Bisbee Police All Plans	$6.76
Rate for Payer: Cash Price	$20.81
Rate for Payer: Self Pay Self Pay	$20.81

Cyclosporine, Blood LC

Facility

OP

$295.00

Service Code	CPT 80158
Hospital Charge Code	1285593
Hospital Revenue Code	301
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Aetna of AZ Medicare	$82.60
Rate for Payer: Allwell Medicare	$47.20
Rate for Payer: Amerigroup Medicare	$47.20
Rate for Payer: APIPA Medicare/Medicaid	$110.18
Rate for Payer: AZCH Complete Medicare	$47.20
Rate for Payer: Banner UC Health Medicare	$47.20
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$200.60
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Copperpoint Commercial	$73.01
Rate for Payer: Health Net of AZ Commercial	$177.00
Rate for Payer: Health Net of AZ Medicare	$82.60
Rate for Payer: Humana of AZ Medicare	$47.20
Rate for Payer: Self Pay Self Pay	$236.00
Rate for Payer: TriWest Medicare	$47.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$171.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.10

Cyclosporine, Blood LC

Facility

IP

$295.00

Service Code	CPT 80158
Hospital Charge Code	1285593
Hospital Revenue Code	301
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Cash Price	$236.00
Rate for Payer: Self Pay Self Pay	$236.00

CYGNUS DUAL 2X3

Facility

IP

$7,666.67

Service Code	CPT Q4282
Hospital Charge Code	27694663
Hospital Revenue Code	636
Min. Negotiated Rate	$1,993.33
Max. Negotiated Rate	$6,900.00
Rate for Payer: Aetna of AZ Commercial	$6,900.00
Rate for Payer: Bisbee Police All Plans	$1,993.33
Rate for Payer: Cash Price	$6,133.34
Rate for Payer: Self Pay Self Pay	$6,133.34

CYGNUS DUAL 2X3

Facility

OP

$7,666.67

Service Code	CPT Q4282
Hospital Charge Code	27694663
Hospital Revenue Code	636
Min. Negotiated Rate	$1,226.67
Max. Negotiated Rate	$6,900.00
Rate for Payer: Aetna of AZ Commercial	$6,900.00
Rate for Payer: Aetna of AZ Medicare	$2,146.67
Rate for Payer: Allwell Medicare	$1,226.67
Rate for Payer: Amerigroup Medicare	$1,226.67
Rate for Payer: APIPA Medicare/Medicaid	$2,863.50
Rate for Payer: AZCH Complete Medicare	$1,226.67
Rate for Payer: Banner UC Health Medicare	$1,226.67
Rate for Payer: Bisbee Police All Plans	$1,993.33
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,213.34
Rate for Payer: Cash Price	$6,133.34
Rate for Payer: Cigna of AZ Commercial	$5,366.67
Rate for Payer: Copperpoint Commercial	$1,897.50
Rate for Payer: Health Net of AZ Commercial	$4,600.00
Rate for Payer: Health Net of AZ Medicare	$2,146.67
Rate for Payer: Humana of AZ Medicare	$1,226.67
Rate for Payer: Self Pay Self Pay	$6,133.34
Rate for Payer: TriWest Medicare	$1,226.67
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,469.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,380.00

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