Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$32,267.91

Service Code	APR-DRG 0924
Hospital Charge Code	APRDRG0922
Min. Negotiated Rate	$32,267.91
Max. Negotiated Rate	$32,267.91
Rate for Payer: AHCCCS Medicaid	$32,267.91
Rate for Payer: Allwell Medicaid	$32,267.91
Rate for Payer: AZCH Complete Medicaid	$32,267.91
Rate for Payer: Banner UC Health Medicaid	$32,267.91
Rate for Payer: Mercy Care Medicaid	$32,267.91

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$17,975.48

Service Code	APR-DRG 0923
Hospital Charge Code	APRDRG0924
Min. Negotiated Rate	$17,975.48
Max. Negotiated Rate	$17,975.48
Rate for Payer: AHCCCS Medicaid	$17,975.48
Rate for Payer: Allwell Medicaid	$17,975.48
Rate for Payer: AZCH Complete Medicaid	$17,975.48
Rate for Payer: Banner UC Health Medicaid	$17,975.48
Rate for Payer: Mercy Care Medicaid	$17,975.48

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$11,444.74

Service Code	APR-DRG 0922
Hospital Charge Code	APRDRG0921
Min. Negotiated Rate	$11,444.74
Max. Negotiated Rate	$11,444.74
Rate for Payer: AHCCCS Medicaid	$11,444.74
Rate for Payer: Allwell Medicaid	$11,444.74
Rate for Payer: AZCH Complete Medicaid	$11,444.74
Rate for Payer: Banner UC Health Medicaid	$11,444.74
Rate for Payer: Mercy Care Medicaid	$11,444.74

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$11,444.74

Service Code	APR-DRG 0922
Hospital Charge Code	APRDRG0922
Min. Negotiated Rate	$11,444.74
Max. Negotiated Rate	$11,444.74
Rate for Payer: AHCCCS Medicaid	$11,444.74
Rate for Payer: Allwell Medicaid	$11,444.74
Rate for Payer: AZCH Complete Medicaid	$11,444.74
Rate for Payer: Banner UC Health Medicaid	$11,444.74
Rate for Payer: Mercy Care Medicaid	$11,444.74

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$8,982.83

Service Code	APR-DRG 0921
Hospital Charge Code	APRDRG0923
Min. Negotiated Rate	$8,982.83
Max. Negotiated Rate	$8,982.83
Rate for Payer: AHCCCS Medicaid	$8,982.83
Rate for Payer: Allwell Medicaid	$8,982.83
Rate for Payer: AZCH Complete Medicaid	$8,982.83
Rate for Payer: Banner UC Health Medicaid	$8,982.83
Rate for Payer: Mercy Care Medicaid	$8,982.83

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$32,267.91

Service Code	APR-DRG 0924
Hospital Charge Code	APRDRG0923
Min. Negotiated Rate	$32,267.91
Max. Negotiated Rate	$32,267.91
Rate for Payer: AHCCCS Medicaid	$32,267.91
Rate for Payer: Allwell Medicaid	$32,267.91
Rate for Payer: AZCH Complete Medicaid	$32,267.91
Rate for Payer: Banner UC Health Medicaid	$32,267.91
Rate for Payer: Mercy Care Medicaid	$32,267.91

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$11,444.74

Service Code	APR-DRG 0922
Hospital Charge Code	APRDRG0924
Min. Negotiated Rate	$11,444.74
Max. Negotiated Rate	$11,444.74
Rate for Payer: AHCCCS Medicaid	$11,444.74
Rate for Payer: Allwell Medicaid	$11,444.74
Rate for Payer: AZCH Complete Medicaid	$11,444.74
Rate for Payer: Banner UC Health Medicaid	$11,444.74
Rate for Payer: Mercy Care Medicaid	$11,444.74

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$32,267.91

Service Code	APR-DRG 0924
Hospital Charge Code	APRDRG0924
Min. Negotiated Rate	$32,267.91
Max. Negotiated Rate	$32,267.91
Rate for Payer: AHCCCS Medicaid	$32,267.91
Rate for Payer: Allwell Medicaid	$32,267.91
Rate for Payer: AZCH Complete Medicaid	$32,267.91
Rate for Payer: Banner UC Health Medicaid	$32,267.91
Rate for Payer: Mercy Care Medicaid	$32,267.91

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$8,982.83

Service Code	APR-DRG 0921
Hospital Charge Code	APRDRG0921
Min. Negotiated Rate	$8,982.83
Max. Negotiated Rate	$8,982.83
Rate for Payer: AHCCCS Medicaid	$8,982.83
Rate for Payer: Allwell Medicaid	$8,982.83
Rate for Payer: AZCH Complete Medicaid	$8,982.83
Rate for Payer: Banner UC Health Medicaid	$8,982.83
Rate for Payer: Mercy Care Medicaid	$8,982.83

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$17,975.48

Service Code	APR-DRG 0923
Hospital Charge Code	APRDRG0921
Min. Negotiated Rate	$17,975.48
Max. Negotiated Rate	$17,975.48
Rate for Payer: AHCCCS Medicaid	$17,975.48
Rate for Payer: Allwell Medicaid	$17,975.48
Rate for Payer: AZCH Complete Medicaid	$17,975.48
Rate for Payer: Banner UC Health Medicaid	$17,975.48
Rate for Payer: Mercy Care Medicaid	$17,975.48

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$32,267.91

Service Code	APR-DRG 0924
Hospital Charge Code	APRDRG0921
Min. Negotiated Rate	$32,267.91
Max. Negotiated Rate	$32,267.91
Rate for Payer: AHCCCS Medicaid	$32,267.91
Rate for Payer: Allwell Medicaid	$32,267.91
Rate for Payer: AZCH Complete Medicaid	$32,267.91
Rate for Payer: Banner UC Health Medicaid	$32,267.91
Rate for Payer: Mercy Care Medicaid	$32,267.91

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$17,975.48

Service Code	APR-DRG 0923
Hospital Charge Code	APRDRG0923
Min. Negotiated Rate	$17,975.48
Max. Negotiated Rate	$17,975.48
Rate for Payer: AHCCCS Medicaid	$17,975.48
Rate for Payer: Allwell Medicaid	$17,975.48
Rate for Payer: AZCH Complete Medicaid	$17,975.48
Rate for Payer: Banner UC Health Medicaid	$17,975.48
Rate for Payer: Mercy Care Medicaid	$17,975.48

Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures

Facility

IP

$11,444.74

Service Code	APR-DRG 0922
Hospital Charge Code	APRDRG0923
Min. Negotiated Rate	$11,444.74
Max. Negotiated Rate	$11,444.74
Rate for Payer: AHCCCS Medicaid	$11,444.74
Rate for Payer: Allwell Medicaid	$11,444.74
Rate for Payer: AZCH Complete Medicaid	$11,444.74
Rate for Payer: Banner UC Health Medicaid	$11,444.74
Rate for Payer: Mercy Care Medicaid	$11,444.74

Factor II Activity LC

Facility

IP

$325.00

Service Code	CPT 85210
Hospital Charge Code	6738704
Hospital Revenue Code	305
Min. Negotiated Rate	$84.50
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Bisbee Police All Plans	$84.50
Rate for Payer: Cash Price	$260.00
Rate for Payer: Self Pay Self Pay	$260.00

Factor II Activity LC

Facility

OP

$325.00

Service Code	CPT 85210
Hospital Charge Code	6738704
Hospital Revenue Code	305
Min. Negotiated Rate	$12.98
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna of AZ Commercial	$292.50
Rate for Payer: Aetna of AZ Medicare	$91.00
Rate for Payer: AHCCCS Medicaid	$12.98
Rate for Payer: Allwell Medicaid	$12.98
Rate for Payer: Allwell Medicare	$48.75
Rate for Payer: Amerigroup Medicare	$48.75
Rate for Payer: APIPA Medicare/Medicaid	$121.39
Rate for Payer: AZCH Complete Medicaid	$12.98
Rate for Payer: AZCH Complete Medicare	$48.75
Rate for Payer: Banner UC Health Medicaid	$12.98
Rate for Payer: Banner UC Health Medicare	$48.75
Rate for Payer: Bisbee Police All Plans	$84.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$221.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cigna of AZ Commercial	$211.25
Rate for Payer: Copperpoint Commercial	$80.44
Rate for Payer: Health Net of AZ Commercial	$195.00
Rate for Payer: Health Net of AZ Medicare	$91.00
Rate for Payer: Humana of AZ Medicare	$48.75
Rate for Payer: Mercy Care Medicaid	$12.98
Rate for Payer: Self Pay Self Pay	$260.00
Rate for Payer: TriWest Medicare	$48.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$189.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.50

Factor II, DNA Analysis LC

Facility

OP

$817.00

Service Code	CPT 81240
Hospital Charge Code	2029232
Hospital Revenue Code	301
Min. Negotiated Rate	$65.69
Max. Negotiated Rate	$735.30
Rate for Payer: Aetna of AZ Commercial	$735.30
Rate for Payer: Aetna of AZ Medicare	$228.76
Rate for Payer: AHCCCS Medicaid	$65.69
Rate for Payer: Allwell Medicaid	$65.69
Rate for Payer: Allwell Medicare	$122.55
Rate for Payer: Amerigroup Medicare	$122.55
Rate for Payer: APIPA Medicare/Medicaid	$305.15
Rate for Payer: AZCH Complete Medicaid	$65.69
Rate for Payer: AZCH Complete Medicare	$122.55
Rate for Payer: Banner UC Health Medicaid	$65.69
Rate for Payer: Banner UC Health Medicare	$122.55
Rate for Payer: Bisbee Police All Plans	$212.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$555.56
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cigna of AZ Commercial	$531.05
Rate for Payer: Copperpoint Commercial	$202.21
Rate for Payer: Health Net of AZ Commercial	$490.20
Rate for Payer: Health Net of AZ Medicare	$228.76
Rate for Payer: Humana of AZ Medicare	$122.55
Rate for Payer: Mercy Care Medicaid	$65.69
Rate for Payer: Self Pay Self Pay	$653.60
Rate for Payer: TriWest Medicare	$122.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$476.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$147.06

Factor II, DNA Analysis LC

Facility

IP

$817.00

Service Code	CPT 81240
Hospital Charge Code	2029232
Hospital Revenue Code	301
Min. Negotiated Rate	$212.42
Max. Negotiated Rate	$735.30
Rate for Payer: Aetna of AZ Commercial	$735.30
Rate for Payer: Bisbee Police All Plans	$212.42
Rate for Payer: Cash Price	$653.60
Rate for Payer: Self Pay Self Pay	$653.60

Factor VIII Activity LC

Facility

IP

$579.00

Service Code	CPT 85240
Hospital Charge Code	1906855
Hospital Revenue Code	305
Min. Negotiated Rate	$150.54
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Bisbee Police All Plans	$150.54
Rate for Payer: Cash Price	$463.20
Rate for Payer: Self Pay Self Pay	$463.20

Factor VIII Activity LC

Facility

OP

$579.00

Service Code	CPT 85240
Hospital Charge Code	1906855
Hospital Revenue Code	305
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$521.10
Rate for Payer: Aetna of AZ Commercial	$521.10
Rate for Payer: Aetna of AZ Medicare	$162.12
Rate for Payer: AHCCCS Medicaid	$17.90
Rate for Payer: Allwell Medicaid	$17.90
Rate for Payer: Allwell Medicare	$86.85
Rate for Payer: Amerigroup Medicare	$86.85
Rate for Payer: APIPA Medicare/Medicaid	$216.26
Rate for Payer: AZCH Complete Medicaid	$17.90
Rate for Payer: AZCH Complete Medicare	$86.85
Rate for Payer: Banner UC Health Medicaid	$17.90
Rate for Payer: Banner UC Health Medicare	$86.85
Rate for Payer: Bisbee Police All Plans	$150.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$393.72
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cigna of AZ Commercial	$376.35
Rate for Payer: Copperpoint Commercial	$143.30
Rate for Payer: Health Net of AZ Commercial	$347.40
Rate for Payer: Health Net of AZ Medicare	$162.12
Rate for Payer: Humana of AZ Medicare	$86.85
Rate for Payer: Mercy Care Medicaid	$17.90
Rate for Payer: Self Pay Self Pay	$463.20
Rate for Payer: TriWest Medicare	$86.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$337.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.22

Factor V Leiden Mutation LC

Facility

OP

$912.00

Service Code	CPT 81241
Hospital Charge Code	1906847
Hospital Revenue Code	301
Min. Negotiated Rate	$73.37
Max. Negotiated Rate	$820.80
Rate for Payer: Aetna of AZ Commercial	$820.80
Rate for Payer: Aetna of AZ Medicare	$255.36
Rate for Payer: AHCCCS Medicaid	$73.37
Rate for Payer: Allwell Medicaid	$73.37
Rate for Payer: Allwell Medicare	$136.80
Rate for Payer: Amerigroup Medicare	$136.80
Rate for Payer: APIPA Medicare/Medicaid	$340.63
Rate for Payer: AZCH Complete Medicaid	$73.37
Rate for Payer: AZCH Complete Medicare	$136.80
Rate for Payer: Banner UC Health Medicaid	$73.37
Rate for Payer: Banner UC Health Medicare	$136.80
Rate for Payer: Bisbee Police All Plans	$237.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$620.16
Rate for Payer: Cash Price	$729.60
Rate for Payer: Cash Price	$729.60
Rate for Payer: Cigna of AZ Commercial	$592.80
Rate for Payer: Copperpoint Commercial	$225.72
Rate for Payer: Health Net of AZ Commercial	$547.20
Rate for Payer: Health Net of AZ Medicare	$255.36
Rate for Payer: Humana of AZ Medicare	$136.80
Rate for Payer: Mercy Care Medicaid	$73.37
Rate for Payer: Self Pay Self Pay	$729.60
Rate for Payer: TriWest Medicare	$136.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$531.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$164.16

Factor V Leiden Mutation LC

Facility

IP

$912.00

Service Code	CPT 81241
Hospital Charge Code	1906847
Hospital Revenue Code	301
Min. Negotiated Rate	$237.12
Max. Negotiated Rate	$820.80
Rate for Payer: Aetna of AZ Commercial	$820.80
Rate for Payer: Bisbee Police All Plans	$237.12
Rate for Payer: Cash Price	$729.60
Rate for Payer: Self Pay Self Pay	$729.60

FALOPE-RING APPLICATION KIT

Facility

IP

$803.00

Hospital Charge Code	22354904
Hospital Revenue Code	270
Min. Negotiated Rate	$208.78
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Cash Price	$642.40
Rate for Payer: Self Pay Self Pay	$642.40

FALOPE-RING APPLICATION KIT

Facility

OP

$803.00

Hospital Charge Code	22354904
Hospital Revenue Code	270
Min. Negotiated Rate	$120.45
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Aetna of AZ Medicare	$224.84
Rate for Payer: Allwell Medicare	$120.45
Rate for Payer: Amerigroup Medicare	$120.45
Rate for Payer: APIPA Medicare/Medicaid	$299.92
Rate for Payer: AZCH Complete Medicare	$120.45
Rate for Payer: Banner UC Health Medicare	$120.45
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$546.04
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cigna of AZ Commercial	$562.10
Rate for Payer: Copperpoint Commercial	$198.74
Rate for Payer: Health Net of AZ Commercial	$481.80
Rate for Payer: Health Net of AZ Medicare	$224.84
Rate for Payer: Humana of AZ Medicare	$120.45
Rate for Payer: Self Pay Self Pay	$642.40
Rate for Payer: TriWest Medicare	$120.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$468.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.54

FALOPE-RING APPLICATION KIT w/TROCAR

Facility

OP

$843.00

Service Code	CPT 58671
Hospital Charge Code	22354903
Hospital Revenue Code	270
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$7,337.64
Rate for Payer: Aetna of AZ Commercial	$758.70
Rate for Payer: Aetna of AZ Medicare	$236.04
Rate for Payer: AHCCCS Medicaid	$7,337.64
Rate for Payer: Allwell Medicaid	$7,337.64
Rate for Payer: Allwell Medicare	$126.45
Rate for Payer: Amerigroup Medicare	$126.45
Rate for Payer: APIPA Medicare/Medicaid	$314.86
Rate for Payer: AZCH Complete Medicaid	$7,337.64
Rate for Payer: AZCH Complete Medicare	$126.45
Rate for Payer: Banner UC Health Medicaid	$7,337.64
Rate for Payer: Banner UC Health Medicare	$126.45
Rate for Payer: Bisbee Police All Plans	$219.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$573.24
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cigna of AZ Commercial	$590.10
Rate for Payer: Copperpoint Commercial	$208.64
Rate for Payer: Health Net of AZ Commercial	$505.80
Rate for Payer: Health Net of AZ Medicare	$236.04
Rate for Payer: Humana of AZ Medicare	$126.45
Rate for Payer: Mercy Care Medicaid	$7,337.64
Rate for Payer: Self Pay Self Pay	$674.40
Rate for Payer: TriWest Medicare	$126.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$151.74

FALOPE-RING APPLICATION KIT w/TROCAR

Facility

IP

$843.00

Service Code	CPT 58671
Hospital Charge Code	22354903
Hospital Revenue Code	270
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$758.70
Rate for Payer: Aetna of AZ Commercial	$758.70
Rate for Payer: Bisbee Police All Plans	$219.18
Rate for Payer: Cash Price	$674.40
Rate for Payer: Self Pay Self Pay	$674.40

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