Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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

Eye Infections And Other Eye Disorders

Facility

IP

$3,833.85

Service Code	APR-DRG 0821
Hospital Charge Code	APRDRG0822
Min. Negotiated Rate	$3,833.85
Max. Negotiated Rate	$3,833.85
Rate for Payer: AHCCCS Medicaid	$3,833.85
Rate for Payer: Allwell Medicaid	$3,833.85
Rate for Payer: AZCH Complete Medicaid	$3,833.85
Rate for Payer: Banner UC Health Medicaid	$3,833.85
Rate for Payer: Mercy Care Medicaid	$3,833.85

Eye Infections And Other Eye Disorders

Facility

IP

$3,833.85

Service Code	APR-DRG 0821
Hospital Charge Code	APRDRG0821
Min. Negotiated Rate	$3,833.85
Max. Negotiated Rate	$3,833.85
Rate for Payer: AHCCCS Medicaid	$3,833.85
Rate for Payer: Allwell Medicaid	$3,833.85
Rate for Payer: AZCH Complete Medicaid	$3,833.85
Rate for Payer: Banner UC Health Medicaid	$3,833.85
Rate for Payer: Mercy Care Medicaid	$3,833.85

Eye Infections And Other Eye Disorders

Facility

IP

$7,170.41

Service Code	APR-DRG 0823
Hospital Charge Code	APRDRG0822
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	APRDRG0823
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	APRDRG0824
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

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	APRDRG0823
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 stream-Ophth irrigation [CQCH]

Facility

OP

$17.53

Service Code	NDC 65053001
Hospital Charge Code	105934956
Hospital Revenue Code	251
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna of AZ Commercial	$15.78
Rate for Payer: Aetna of AZ Medicare	$4.91
Rate for Payer: Allwell Medicare	$2.80
Rate for Payer: Amerigroup Medicare	$2.80
Rate for Payer: APIPA Medicare/Medicaid	$6.55
Rate for Payer: AZCH Complete Medicare	$2.80
Rate for Payer: Banner UC Health Medicare	$2.80
Rate for Payer: Bisbee Police All Plans	$4.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$11.92
Rate for Payer: Cash Price	$14.02
Rate for Payer: Cigna of AZ Commercial	$11.39
Rate for Payer: Copperpoint Commercial	$4.34
Rate for Payer: Health Net of AZ Commercial	$10.52
Rate for Payer: Health Net of AZ Medicare	$4.91
Rate for Payer: Humana of AZ Medicare	$2.80
Rate for Payer: Self Pay Self Pay	$14.02
Rate for Payer: TriWest Medicare	$2.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.16

Eye stream-Ophth irrigation [CQCH]

Facility

IP

$17.53

Service Code	NDC 65053001
Hospital Charge Code	105934956
Hospital Revenue Code	251
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$15.78
Rate for Payer: Aetna of AZ Commercial	$15.78
Rate for Payer: Bisbee Police All Plans	$4.56
Rate for Payer: Cash Price	$14.02
Rate for Payer: Self Pay Self Pay	$14.02

EZDILATE BALLOON DILATOR 18-20

Facility

OP

$1,205.00

Hospital Charge Code	27387880
Hospital Revenue Code	270
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$1,084.50
Rate for Payer: Aetna of AZ Commercial	$1,084.50
Rate for Payer: Aetna of AZ Medicare	$337.40
Rate for Payer: Allwell Medicare	$192.80
Rate for Payer: Amerigroup Medicare	$192.80
Rate for Payer: APIPA Medicare/Medicaid	$450.07
Rate for Payer: AZCH Complete Medicare	$192.80
Rate for Payer: Banner UC Health Medicare	$192.80
Rate for Payer: Bisbee Police All Plans	$313.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$819.40
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cigna of AZ Commercial	$843.50
Rate for Payer: Copperpoint Commercial	$298.24
Rate for Payer: Health Net of AZ Commercial	$723.00
Rate for Payer: Health Net of AZ Medicare	$337.40
Rate for Payer: Humana of AZ Medicare	$192.80
Rate for Payer: Self Pay Self Pay	$964.00
Rate for Payer: TriWest Medicare	$192.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$702.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$216.90

EZDILATE BALLOON DILATOR 18-20

Facility

IP

$1,205.00

Hospital Charge Code	27387880
Hospital Revenue Code	270
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$1,084.50
Rate for Payer: Aetna of AZ Commercial	$1,084.50
Rate for Payer: Bisbee Police All Plans	$313.30
Rate for Payer: Cash Price	$964.00
Rate for Payer: Self Pay Self Pay	$964.00

EZDILATE ENDO BALLONE DILATOR 13.5MM TO 15.5MM

Facility

OP

$1,395.00

Hospital Charge Code	28042254
Hospital Revenue Code	270
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Aetna of AZ Medicare	$390.60
Rate for Payer: Allwell Medicare	$223.20
Rate for Payer: Amerigroup Medicare	$223.20
Rate for Payer: APIPA Medicare/Medicaid	$521.03
Rate for Payer: AZCH Complete Medicare	$223.20
Rate for Payer: Banner UC Health Medicare	$223.20
Rate for Payer: Bisbee Police All Plans	$362.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$948.60
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Cigna of AZ Commercial	$976.50
Rate for Payer: Copperpoint Commercial	$345.26
Rate for Payer: Health Net of AZ Commercial	$837.00
Rate for Payer: Health Net of AZ Medicare	$390.60
Rate for Payer: Humana of AZ Medicare	$223.20
Rate for Payer: Self Pay Self Pay	$1,116.00
Rate for Payer: TriWest Medicare	$223.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$813.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$251.10

EZDILATE ENDO BALLONE DILATOR 13.5MM TO 15.5MM

Facility

IP

$1,395.00

Hospital Charge Code	28042254
Hospital Revenue Code	270
Min. Negotiated Rate	$362.70
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Bisbee Police All Plans	$362.70
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Self Pay Self Pay	$1,116.00

EZDILATE ENDO BALLOON DILATOR 16MM TO 18MM

Facility

OP

$1,395.00

Hospital Charge Code	28042256
Hospital Revenue Code	270
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Aetna of AZ Medicare	$390.60
Rate for Payer: Allwell Medicare	$223.20
Rate for Payer: Amerigroup Medicare	$223.20
Rate for Payer: APIPA Medicare/Medicaid	$521.03
Rate for Payer: AZCH Complete Medicare	$223.20
Rate for Payer: Banner UC Health Medicare	$223.20
Rate for Payer: Bisbee Police All Plans	$362.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$948.60
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Cigna of AZ Commercial	$976.50
Rate for Payer: Copperpoint Commercial	$345.26
Rate for Payer: Health Net of AZ Commercial	$837.00
Rate for Payer: Health Net of AZ Medicare	$390.60
Rate for Payer: Humana of AZ Medicare	$223.20
Rate for Payer: Self Pay Self Pay	$1,116.00
Rate for Payer: TriWest Medicare	$223.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$813.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$251.10

EZDILATE ENDO BALLOON DILATOR 16MM TO 18MM

Facility

IP

$1,395.00

Hospital Charge Code	28042256
Hospital Revenue Code	270
Min. Negotiated Rate	$362.70
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna of AZ Commercial	$1,255.50
Rate for Payer: Bisbee Police All Plans	$362.70
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Self Pay Self Pay	$1,116.00

F002-IgE Milk (Cow) LC

Facility

OP

$60.00

Service Code	CPT 86003
Hospital Charge Code	2269479
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

F002-IgE Milk (Cow) LC

Facility

IP

$60.00

Service Code	CPT 86003
Hospital Charge Code	2269479
Hospital Revenue Code	302
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

F004-IgE Wheat LC

Facility

OP

$48.00

Service Code	CPT 86003
Hospital Charge Code	2269464
Hospital Revenue Code	302
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: Allwell Medicare	$7.68
Rate for Payer: Amerigroup Medicare	$7.68
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicare	$7.68
Rate for Payer: Banner UC Health Medicare	$7.68
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$31.20
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.68
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

F004-IgE Wheat LC

Facility

IP

$48.00

Service Code	CPT 86003
Hospital Charge Code	2269464
Hospital Revenue Code	302
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

F044-IgE Strawberry LC

Facility

IP

$58.00

Service Code	CPT 86003
Hospital Charge Code	2087586
Hospital Revenue Code	302
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

F044-IgE Strawberry LC

Facility

OP

$58.00

Service Code	CPT 86003
Hospital Charge Code	2087586
Hospital Revenue Code	302
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$9.28
Rate for Payer: Amerigroup Medicare	$9.28
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$9.28
Rate for Payer: Banner UC Health Medicare	$9.28
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$37.70
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$9.28
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$9.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

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

$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

$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

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