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

$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

$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	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

$8,982.83

Service Code	APR-DRG 0921
Hospital Charge Code	APRDRG0924
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

$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

$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

$17,975.48

Service Code	APR-DRG 0923
Hospital Charge Code	APRDRG0922
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	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

$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

$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

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	APRDRG0922
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

Factor II Activity LC

Facility

OP

$325.00

Service Code	CPT 85210
Hospital Charge Code	6738704
Hospital Revenue Code	305
Min. Negotiated Rate	$52.00
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: Allwell Medicare	$52.00
Rate for Payer: Amerigroup Medicare	$52.00
Rate for Payer: APIPA Medicare/Medicaid	$121.39
Rate for Payer: AZCH Complete Medicare	$52.00
Rate for Payer: Banner UC Health Medicare	$52.00
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: 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	$52.00
Rate for Payer: Self Pay Self Pay	$260.00
Rate for Payer: TriWest Medicare	$52.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$189.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.50

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, DNA Analysis LC

Facility

OP

$776.00

Service Code	CPT 81240
Hospital Charge Code	2029232
Hospital Revenue Code	301
Min. Negotiated Rate	$124.16
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Aetna of AZ Medicare	$217.28
Rate for Payer: Allwell Medicare	$124.16
Rate for Payer: Amerigroup Medicare	$124.16
Rate for Payer: APIPA Medicare/Medicaid	$289.84
Rate for Payer: AZCH Complete Medicare	$124.16
Rate for Payer: Banner UC Health Medicare	$124.16
Rate for Payer: Bisbee Police All Plans	$201.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$527.68
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cigna of AZ Commercial	$504.40
Rate for Payer: Copperpoint Commercial	$192.06
Rate for Payer: Health Net of AZ Commercial	$465.60
Rate for Payer: Health Net of AZ Medicare	$217.28
Rate for Payer: Humana of AZ Medicare	$124.16
Rate for Payer: Self Pay Self Pay	$620.80
Rate for Payer: TriWest Medicare	$124.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$452.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$139.68

Factor II, DNA Analysis LC

Facility

IP

$776.00

Service Code	CPT 81240
Hospital Charge Code	2029232
Hospital Revenue Code	301
Min. Negotiated Rate	$201.76
Max. Negotiated Rate	$698.40
Rate for Payer: Aetna of AZ Commercial	$698.40
Rate for Payer: Bisbee Police All Plans	$201.76
Rate for Payer: Cash Price	$620.80
Rate for Payer: Self Pay Self Pay	$620.80

Factor VIII Activity LC

Facility

OP

$550.00

Service Code	CPT 85240
Hospital Charge Code	1906855
Hospital Revenue Code	305
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna of AZ Commercial	$495.00
Rate for Payer: Aetna of AZ Medicare	$154.00
Rate for Payer: Allwell Medicare	$88.00
Rate for Payer: Amerigroup Medicare	$88.00
Rate for Payer: APIPA Medicare/Medicaid	$205.43
Rate for Payer: AZCH Complete Medicare	$88.00
Rate for Payer: Banner UC Health Medicare	$88.00
Rate for Payer: Bisbee Police All Plans	$143.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Cigna of AZ Commercial	$357.50
Rate for Payer: Copperpoint Commercial	$136.12
Rate for Payer: Health Net of AZ Commercial	$330.00
Rate for Payer: Health Net of AZ Medicare	$154.00
Rate for Payer: Humana of AZ Medicare	$88.00
Rate for Payer: Self Pay Self Pay	$440.00
Rate for Payer: TriWest Medicare	$88.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$320.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.00

Factor VIII Activity LC

Facility

IP

$550.00

Service Code	CPT 85240
Hospital Charge Code	1906855
Hospital Revenue Code	305
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna of AZ Commercial	$495.00
Rate for Payer: Bisbee Police All Plans	$143.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Self Pay Self Pay	$440.00

Factor V Leiden Mutation LC

Facility

OP

$866.00

Service Code	CPT 81241
Hospital Charge Code	1906847
Hospital Revenue Code	301
Min. Negotiated Rate	$138.56
Max. Negotiated Rate	$779.40
Rate for Payer: Aetna of AZ Commercial	$779.40
Rate for Payer: Aetna of AZ Medicare	$242.48
Rate for Payer: Allwell Medicare	$138.56
Rate for Payer: Amerigroup Medicare	$138.56
Rate for Payer: APIPA Medicare/Medicaid	$323.45
Rate for Payer: AZCH Complete Medicare	$138.56
Rate for Payer: Banner UC Health Medicare	$138.56
Rate for Payer: Bisbee Police All Plans	$225.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$588.88
Rate for Payer: Cash Price	$692.80
Rate for Payer: Cigna of AZ Commercial	$562.90
Rate for Payer: Copperpoint Commercial	$214.34
Rate for Payer: Health Net of AZ Commercial	$519.60
Rate for Payer: Health Net of AZ Medicare	$242.48
Rate for Payer: Humana of AZ Medicare	$138.56
Rate for Payer: Self Pay Self Pay	$692.80
Rate for Payer: TriWest Medicare	$138.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$504.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.88

Factor V Leiden Mutation LC

Facility

IP

$866.00

Service Code	CPT 81241
Hospital Charge Code	1906847
Hospital Revenue Code	301
Min. Negotiated Rate	$225.16
Max. Negotiated Rate	$779.40
Rate for Payer: Aetna of AZ Commercial	$779.40
Rate for Payer: Bisbee Police All Plans	$225.16
Rate for Payer: Cash Price	$692.80
Rate for Payer: Self Pay Self Pay	$692.80

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	$128.48
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	$128.48
Rate for Payer: Amerigroup Medicare	$128.48
Rate for Payer: APIPA Medicare/Medicaid	$299.92
Rate for Payer: AZCH Complete Medicare	$128.48
Rate for Payer: Banner UC Health Medicare	$128.48
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	$128.48
Rate for Payer: Self Pay Self Pay	$642.40
Rate for Payer: TriWest Medicare	$128.48
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

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

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	$134.88
Max. Negotiated Rate	$3,668.82
Rate for Payer: Aetna of AZ Commercial	$758.70
Rate for Payer: Aetna of AZ Medicare	$236.04
Rate for Payer: AHCCCS Medicaid	$3,668.82
Rate for Payer: Allwell Medicaid	$3,668.82
Rate for Payer: Allwell Medicare	$134.88
Rate for Payer: Amerigroup Medicare	$134.88
Rate for Payer: APIPA Medicare/Medicaid	$314.86
Rate for Payer: AZCH Complete Medicaid	$3,668.82
Rate for Payer: AZCH Complete Medicare	$134.88
Rate for Payer: Banner UC Health Medicaid	$3,668.82
Rate for Payer: Banner UC Health Medicare	$134.88
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	$134.88
Rate for Payer: Mercy Care Medicaid	$3,668.82
Rate for Payer: Self Pay Self Pay	$674.40
Rate for Payer: TriWest Medicare	$134.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$491.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$151.74

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