Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: AHCCCS Medicaid	$32,993.15
Rate for Payer: Allwell Medicaid	$32,993.15
Rate for Payer: AZCH Complete Medicaid	$32,993.15
Rate for Payer: Banner UC Health Medicaid	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: AHCCCS Medicaid	$32,993.15
Rate for Payer: Allwell Medicaid	$32,993.15
Rate for Payer: AZCH Complete Medicaid	$32,993.15
Rate for Payer: Banner UC Health Medicaid	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: AHCCCS Medicaid	$55,111.80
Rate for Payer: Allwell Medicaid	$55,111.80
Rate for Payer: AZCH Complete Medicaid	$55,111.80
Rate for Payer: Banner UC Health Medicaid	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: AHCCCS Medicaid	$32,993.15
Rate for Payer: Allwell Medicaid	$32,993.15
Rate for Payer: AZCH Complete Medicaid	$32,993.15
Rate for Payer: Banner UC Health Medicaid	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: AHCCCS Medicaid	$124,520.24
Rate for Payer: Allwell Medicaid	$124,520.24
Rate for Payer: AZCH Complete Medicaid	$124,520.24
Rate for Payer: Banner UC Health Medicaid	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0094
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: AHCCCS Medicaid	$124,520.24
Rate for Payer: Allwell Medicaid	$124,520.24
Rate for Payer: AZCH Complete Medicaid	$124,520.24
Rate for Payer: Banner UC Health Medicaid	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: AHCCCS Medicaid	$55,111.80
Rate for Payer: Allwell Medicaid	$55,111.80
Rate for Payer: AZCH Complete Medicaid	$55,111.80
Rate for Payer: Banner UC Health Medicaid	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: AHCCCS Medicaid	$124,520.24
Rate for Payer: Allwell Medicaid	$124,520.24
Rate for Payer: AZCH Complete Medicaid	$124,520.24
Rate for Payer: Banner UC Health Medicaid	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$124,520.24

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG0093
Min. Negotiated Rate	$124,520.24
Max. Negotiated Rate	$124,520.24
Rate for Payer: AHCCCS Medicaid	$124,520.24
Rate for Payer: Allwell Medicaid	$124,520.24
Rate for Payer: AZCH Complete Medicaid	$124,520.24
Rate for Payer: Banner UC Health Medicaid	$124,520.24
Rate for Payer: Mercy Care Medicaid	$124,520.24

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$55,111.80

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG0091
Min. Negotiated Rate	$55,111.80
Max. Negotiated Rate	$55,111.80
Rate for Payer: AHCCCS Medicaid	$55,111.80
Rate for Payer: Allwell Medicaid	$55,111.80
Rate for Payer: AZCH Complete Medicaid	$55,111.80
Rate for Payer: Banner UC Health Medicaid	$55,111.80
Rate for Payer: Mercy Care Medicaid	$55,111.80

Extracorporeal Membrane Oxygenation (Ecmo)

Facility

IP

$32,993.15

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG0092
Min. Negotiated Rate	$32,993.15
Max. Negotiated Rate	$32,993.15
Rate for Payer: AHCCCS Medicaid	$32,993.15
Rate for Payer: Allwell Medicaid	$32,993.15
Rate for Payer: AZCH Complete Medicaid	$32,993.15
Rate for Payer: Banner UC Health Medicaid	$32,993.15
Rate for Payer: Mercy Care Medicaid	$32,993.15

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NR

Facility

IP

$107.00

Service Code	CPT 86235
Hospital Charge Code	23298041
Hospital Revenue Code	301
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Cash Price	$85.60
Rate for Payer: Self Pay Self Pay	$85.60

EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NR

Facility

OP

$107.00

Service Code	CPT 86235
Hospital Charge Code	23298041
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$96.30
Rate for Payer: Aetna of AZ Commercial	$96.30
Rate for Payer: Aetna of AZ Medicare	$29.96
Rate for Payer: AHCCCS Medicaid	$17.93
Rate for Payer: Allwell Medicaid	$17.93
Rate for Payer: Allwell Medicare	$16.05
Rate for Payer: Amerigroup Medicare	$16.05
Rate for Payer: APIPA Medicare/Medicaid	$39.96
Rate for Payer: AZCH Complete Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$16.05
Rate for Payer: Banner UC Health Medicaid	$17.93
Rate for Payer: Banner UC Health Medicare	$16.05
Rate for Payer: Bisbee Police All Plans	$27.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.76
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cigna of AZ Commercial	$69.55
Rate for Payer: Copperpoint Commercial	$26.48
Rate for Payer: Health Net of AZ Commercial	$64.20
Rate for Payer: Health Net of AZ Medicare	$29.96
Rate for Payer: Humana of AZ Medicare	$16.05
Rate for Payer: Mercy Care Medicaid	$17.93
Rate for Payer: Self Pay Self Pay	$85.60
Rate for Payer: TriWest Medicare	$16.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$62.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.26

EXTRACTOR STONE 2.8F NTRAP

Facility

IP

$1,686.00

Hospital Charge Code	22354228
Hospital Revenue Code	270
Min. Negotiated Rate	$438.36
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Bisbee Police All Plans	$438.36
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Self Pay Self Pay	$1,348.80

EXTRACTOR STONE 2.8F NTRAP

Facility

OP

$1,686.00

Hospital Charge Code	22354228
Hospital Revenue Code	270
Min. Negotiated Rate	$252.90
Max. Negotiated Rate	$1,517.40
Rate for Payer: Aetna of AZ Commercial	$1,517.40
Rate for Payer: Aetna of AZ Medicare	$472.08
Rate for Payer: Allwell Medicare	$252.90
Rate for Payer: Amerigroup Medicare	$252.90
Rate for Payer: APIPA Medicare/Medicaid	$629.72
Rate for Payer: AZCH Complete Medicare	$252.90
Rate for Payer: Banner UC Health Medicare	$252.90
Rate for Payer: Bisbee Police All Plans	$438.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,146.48
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Cigna of AZ Commercial	$1,180.20
Rate for Payer: Copperpoint Commercial	$417.28
Rate for Payer: Health Net of AZ Commercial	$1,011.60
Rate for Payer: Health Net of AZ Medicare	$472.08
Rate for Payer: Humana of AZ Medicare	$252.90
Rate for Payer: Self Pay Self Pay	$1,348.80
Rate for Payer: TriWest Medicare	$252.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$982.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$303.48

EXTRACTOR STONE NCIRCLE TIPLESS 2.2F

Facility

OP

$712.00

Hospital Charge Code	22354219
Hospital Revenue Code	270
Min. Negotiated Rate	$106.80
Max. Negotiated Rate	$640.80
Rate for Payer: Aetna of AZ Commercial	$640.80
Rate for Payer: Aetna of AZ Medicare	$199.36
Rate for Payer: Allwell Medicare	$106.80
Rate for Payer: Amerigroup Medicare	$106.80
Rate for Payer: APIPA Medicare/Medicaid	$265.93
Rate for Payer: AZCH Complete Medicare	$106.80
Rate for Payer: Banner UC Health Medicare	$106.80
Rate for Payer: Bisbee Police All Plans	$185.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$484.16
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cigna of AZ Commercial	$498.40
Rate for Payer: Copperpoint Commercial	$176.22
Rate for Payer: Health Net of AZ Commercial	$427.20
Rate for Payer: Health Net of AZ Medicare	$199.36
Rate for Payer: Humana of AZ Medicare	$106.80
Rate for Payer: Self Pay Self Pay	$569.60
Rate for Payer: TriWest Medicare	$106.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$415.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.16

EXTRACTOR STONE NCIRCLE TIPLESS 2.2F

Facility

IP

$712.00

Hospital Charge Code	22354219
Hospital Revenue Code	270
Min. Negotiated Rate	$185.12
Max. Negotiated Rate	$640.80
Rate for Payer: Aetna of AZ Commercial	$640.80
Rate for Payer: Bisbee Police All Plans	$185.12
Rate for Payer: Cash Price	$569.60
Rate for Payer: Self Pay Self Pay	$569.60

EXTRACTOR STONE NCIRCLE TIPLESS 4.5F

Facility

IP

$818.00

Hospital Charge Code	22354217
Hospital Revenue Code	270
Min. Negotiated Rate	$212.68
Max. Negotiated Rate	$736.20
Rate for Payer: Aetna of AZ Commercial	$736.20
Rate for Payer: Bisbee Police All Plans	$212.68
Rate for Payer: Cash Price	$654.40
Rate for Payer: Self Pay Self Pay	$654.40

EXTRACTOR STONE NCIRCLE TIPLESS 4.5F

Facility

OP

$818.00

Hospital Charge Code	22354217
Hospital Revenue Code	270
Min. Negotiated Rate	$122.70
Max. Negotiated Rate	$736.20
Rate for Payer: Aetna of AZ Commercial	$736.20
Rate for Payer: Aetna of AZ Medicare	$229.04
Rate for Payer: Allwell Medicare	$122.70
Rate for Payer: Amerigroup Medicare	$122.70
Rate for Payer: APIPA Medicare/Medicaid	$305.52
Rate for Payer: AZCH Complete Medicare	$122.70
Rate for Payer: Banner UC Health Medicare	$122.70
Rate for Payer: Bisbee Police All Plans	$212.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$556.24
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cigna of AZ Commercial	$572.60
Rate for Payer: Copperpoint Commercial	$202.46
Rate for Payer: Health Net of AZ Commercial	$490.80
Rate for Payer: Health Net of AZ Medicare	$229.04
Rate for Payer: Humana of AZ Medicare	$122.70
Rate for Payer: Self Pay Self Pay	$654.40
Rate for Payer: TriWest Medicare	$122.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$476.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$147.24

EXTRACTOR STONE NCOMPASS 2.4F

Facility

IP

$752.00

Hospital Charge Code	22354227
Hospital Revenue Code	270
Min. Negotiated Rate	$195.52
Max. Negotiated Rate	$676.80
Rate for Payer: Aetna of AZ Commercial	$676.80
Rate for Payer: Bisbee Police All Plans	$195.52
Rate for Payer: Cash Price	$601.60
Rate for Payer: Self Pay Self Pay	$601.60

EXTRACTOR STONE NCOMPASS 2.4F

Facility

OP

$752.00

Hospital Charge Code	22354227
Hospital Revenue Code	270
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$676.80
Rate for Payer: Aetna of AZ Commercial	$676.80
Rate for Payer: Aetna of AZ Medicare	$210.56
Rate for Payer: Allwell Medicare	$112.80
Rate for Payer: Amerigroup Medicare	$112.80
Rate for Payer: APIPA Medicare/Medicaid	$280.87
Rate for Payer: AZCH Complete Medicare	$112.80
Rate for Payer: Banner UC Health Medicare	$112.80
Rate for Payer: Bisbee Police All Plans	$195.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$511.36
Rate for Payer: Cash Price	$601.60
Rate for Payer: Cigna of AZ Commercial	$526.40
Rate for Payer: Copperpoint Commercial	$186.12
Rate for Payer: Health Net of AZ Commercial	$451.20
Rate for Payer: Health Net of AZ Medicare	$210.56
Rate for Payer: Humana of AZ Medicare	$112.80
Rate for Payer: Self Pay Self Pay	$601.60
Rate for Payer: TriWest Medicare	$112.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$438.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$135.36

Eye Infections And Other Eye Disorders

Facility

IP

$16,680.69

Service Code	APR-DRG 0824
Hospital Charge Code	APRDRG0821
Min. Negotiated Rate	$16,680.69
Max. Negotiated Rate	$16,680.69
Rate for Payer: AHCCCS Medicaid	$16,680.69
Rate for Payer: Allwell Medicaid	$16,680.69
Rate for Payer: AZCH Complete Medicaid	$16,680.69
Rate for Payer: Banner UC Health Medicaid	$16,680.69
Rate for Payer: Mercy Care Medicaid	$16,680.69

Eye Infections And Other Eye Disorders

Facility

IP

$7,170.41

Service Code	APR-DRG 0823
Hospital Charge Code	APRDRG0821
Min. Negotiated Rate	$7,170.41
Max. Negotiated Rate	$7,170.41
Rate for Payer: AHCCCS Medicaid	$7,170.41
Rate for Payer: Allwell Medicaid	$7,170.41
Rate for Payer: AZCH Complete Medicaid	$7,170.41
Rate for Payer: Banner UC Health Medicaid	$7,170.41
Rate for Payer: Mercy Care Medicaid	$7,170.41

Eye Infections And Other Eye Disorders

Facility

IP

$16,680.69

Service Code	APR-DRG 0824
Hospital Charge Code	APRDRG0824
Min. Negotiated Rate	$16,680.69
Max. Negotiated Rate	$16,680.69
Rate for Payer: AHCCCS Medicaid	$16,680.69
Rate for Payer: Allwell Medicaid	$16,680.69
Rate for Payer: AZCH Complete Medicaid	$16,680.69
Rate for Payer: Banner UC Health Medicaid	$16,680.69
Rate for Payer: Mercy Care Medicaid	$16,680.69

Eye Infections And Other Eye Disorders

Facility

IP

$4,676.94

Service Code	APR-DRG 0822
Hospital Charge Code	APRDRG0821
Min. Negotiated Rate	$4,676.94
Max. Negotiated Rate	$4,676.94
Rate for Payer: AHCCCS Medicaid	$4,676.94
Rate for Payer: Allwell Medicaid	$4,676.94
Rate for Payer: AZCH Complete Medicaid	$4,676.94
Rate for Payer: Banner UC Health Medicaid	$4,676.94
Rate for Payer: Mercy Care Medicaid	$4,676.94

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