Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

.HE4 Methodology LC

Facility

IP

$377.00

Service Code	CPT 86305
Hospital Charge Code	22311147
Hospital Revenue Code	302
Min. Negotiated Rate	$98.02
Max. Negotiated Rate	$339.30
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Bisbee Police All Plans	$98.02
Rate for Payer: Cash Price	$301.60
Rate for Payer: Self Pay Self Pay	$301.60

.HE4 Methodology LC

Facility

OP

$377.00

Service Code	CPT 86305
Hospital Charge Code	22311147
Hospital Revenue Code	302
Min. Negotiated Rate	$60.32
Max. Negotiated Rate	$339.30
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Aetna of AZ Medicare	$105.56
Rate for Payer: Allwell Medicare	$60.32
Rate for Payer: Amerigroup Medicare	$60.32
Rate for Payer: APIPA Medicare/Medicaid	$140.81
Rate for Payer: AZCH Complete Medicare	$60.32
Rate for Payer: Banner UC Health Medicare	$60.32
Rate for Payer: Bisbee Police All Plans	$98.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$256.36
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cigna of AZ Commercial	$245.05
Rate for Payer: Copperpoint Commercial	$93.31
Rate for Payer: Health Net of AZ Commercial	$226.20
Rate for Payer: Health Net of AZ Medicare	$105.56
Rate for Payer: Humana of AZ Medicare	$60.32
Rate for Payer: Self Pay Self Pay	$301.60
Rate for Payer: TriWest Medicare	$60.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$219.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$67.86

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$6,528.63

Service Code	APR-DRG 0552
Hospital Charge Code	APRDRG0554
Min. Negotiated Rate	$6,528.63
Max. Negotiated Rate	$6,528.63
Rate for Payer: AHCCCS Medicaid	$6,528.63
Rate for Payer: Allwell Medicaid	$6,528.63
Rate for Payer: AZCH Complete Medicaid	$6,528.63
Rate for Payer: Banner UC Health Medicaid	$6,528.63
Rate for Payer: Mercy Care Medicaid	$6,528.63

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$4,799.68

Service Code	APR-DRG 0551
Hospital Charge Code	APRDRG0554
Min. Negotiated Rate	$4,799.68
Max. Negotiated Rate	$4,799.68
Rate for Payer: AHCCCS Medicaid	$4,799.68
Rate for Payer: Allwell Medicaid	$4,799.68
Rate for Payer: AZCH Complete Medicaid	$4,799.68
Rate for Payer: Banner UC Health Medicaid	$4,799.68
Rate for Payer: Mercy Care Medicaid	$4,799.68

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$6,528.63

Service Code	APR-DRG 0552
Hospital Charge Code	APRDRG0551
Min. Negotiated Rate	$6,528.63
Max. Negotiated Rate	$6,528.63
Rate for Payer: AHCCCS Medicaid	$6,528.63
Rate for Payer: Allwell Medicaid	$6,528.63
Rate for Payer: AZCH Complete Medicaid	$6,528.63
Rate for Payer: Banner UC Health Medicaid	$6,528.63
Rate for Payer: Mercy Care Medicaid	$6,528.63

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$6,528.63

Service Code	APR-DRG 0552
Hospital Charge Code	APRDRG0552
Min. Negotiated Rate	$6,528.63
Max. Negotiated Rate	$6,528.63
Rate for Payer: AHCCCS Medicaid	$6,528.63
Rate for Payer: Allwell Medicaid	$6,528.63
Rate for Payer: AZCH Complete Medicaid	$6,528.63
Rate for Payer: Banner UC Health Medicaid	$6,528.63
Rate for Payer: Mercy Care Medicaid	$6,528.63

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$4,799.68

Service Code	APR-DRG 0551
Hospital Charge Code	APRDRG0552
Min. Negotiated Rate	$4,799.68
Max. Negotiated Rate	$4,799.68
Rate for Payer: AHCCCS Medicaid	$4,799.68
Rate for Payer: Allwell Medicaid	$4,799.68
Rate for Payer: AZCH Complete Medicaid	$4,799.68
Rate for Payer: Banner UC Health Medicaid	$4,799.68
Rate for Payer: Mercy Care Medicaid	$4,799.68

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$6,528.63

Service Code	APR-DRG 0552
Hospital Charge Code	APRDRG0553
Min. Negotiated Rate	$6,528.63
Max. Negotiated Rate	$6,528.63
Rate for Payer: AHCCCS Medicaid	$6,528.63
Rate for Payer: Allwell Medicaid	$6,528.63
Rate for Payer: AZCH Complete Medicaid	$6,528.63
Rate for Payer: Banner UC Health Medicaid	$6,528.63
Rate for Payer: Mercy Care Medicaid	$6,528.63

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$9,925.51

Service Code	APR-DRG 0553
Hospital Charge Code	APRDRG0551
Min. Negotiated Rate	$9,925.51
Max. Negotiated Rate	$9,925.51
Rate for Payer: AHCCCS Medicaid	$9,925.51
Rate for Payer: Allwell Medicaid	$9,925.51
Rate for Payer: AZCH Complete Medicaid	$9,925.51
Rate for Payer: Banner UC Health Medicaid	$9,925.51
Rate for Payer: Mercy Care Medicaid	$9,925.51

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$4,799.68

Service Code	APR-DRG 0551
Hospital Charge Code	APRDRG0551
Min. Negotiated Rate	$4,799.68
Max. Negotiated Rate	$4,799.68
Rate for Payer: AHCCCS Medicaid	$4,799.68
Rate for Payer: Allwell Medicaid	$4,799.68
Rate for Payer: AZCH Complete Medicaid	$4,799.68
Rate for Payer: Banner UC Health Medicaid	$4,799.68
Rate for Payer: Mercy Care Medicaid	$4,799.68

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$9,925.51

Service Code	APR-DRG 0553
Hospital Charge Code	APRDRG0552
Min. Negotiated Rate	$9,925.51
Max. Negotiated Rate	$9,925.51
Rate for Payer: AHCCCS Medicaid	$9,925.51
Rate for Payer: Allwell Medicaid	$9,925.51
Rate for Payer: AZCH Complete Medicaid	$9,925.51
Rate for Payer: Banner UC Health Medicaid	$9,925.51
Rate for Payer: Mercy Care Medicaid	$9,925.51

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$20,073.37

Service Code	APR-DRG 0554
Hospital Charge Code	APRDRG0551
Min. Negotiated Rate	$20,073.37
Max. Negotiated Rate	$20,073.37
Rate for Payer: AHCCCS Medicaid	$20,073.37
Rate for Payer: Allwell Medicaid	$20,073.37
Rate for Payer: AZCH Complete Medicaid	$20,073.37
Rate for Payer: Banner UC Health Medicaid	$20,073.37
Rate for Payer: Mercy Care Medicaid	$20,073.37

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$9,925.51

Service Code	APR-DRG 0553
Hospital Charge Code	APRDRG0553
Min. Negotiated Rate	$9,925.51
Max. Negotiated Rate	$9,925.51
Rate for Payer: AHCCCS Medicaid	$9,925.51
Rate for Payer: Allwell Medicaid	$9,925.51
Rate for Payer: AZCH Complete Medicaid	$9,925.51
Rate for Payer: Banner UC Health Medicaid	$9,925.51
Rate for Payer: Mercy Care Medicaid	$9,925.51

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$4,799.68

Service Code	APR-DRG 0551
Hospital Charge Code	APRDRG0553
Min. Negotiated Rate	$4,799.68
Max. Negotiated Rate	$4,799.68
Rate for Payer: AHCCCS Medicaid	$4,799.68
Rate for Payer: Allwell Medicaid	$4,799.68
Rate for Payer: AZCH Complete Medicaid	$4,799.68
Rate for Payer: Banner UC Health Medicaid	$4,799.68
Rate for Payer: Mercy Care Medicaid	$4,799.68

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$20,073.37

Service Code	APR-DRG 0554
Hospital Charge Code	APRDRG0553
Min. Negotiated Rate	$20,073.37
Max. Negotiated Rate	$20,073.37
Rate for Payer: AHCCCS Medicaid	$20,073.37
Rate for Payer: Allwell Medicaid	$20,073.37
Rate for Payer: AZCH Complete Medicaid	$20,073.37
Rate for Payer: Banner UC Health Medicaid	$20,073.37
Rate for Payer: Mercy Care Medicaid	$20,073.37

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$20,073.37

Service Code	APR-DRG 0554
Hospital Charge Code	APRDRG0552
Min. Negotiated Rate	$20,073.37
Max. Negotiated Rate	$20,073.37
Rate for Payer: AHCCCS Medicaid	$20,073.37
Rate for Payer: Allwell Medicaid	$20,073.37
Rate for Payer: AZCH Complete Medicaid	$20,073.37
Rate for Payer: Banner UC Health Medicaid	$20,073.37
Rate for Payer: Mercy Care Medicaid	$20,073.37

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$20,073.37

Service Code	APR-DRG 0554
Hospital Charge Code	APRDRG0554
Min. Negotiated Rate	$20,073.37
Max. Negotiated Rate	$20,073.37
Rate for Payer: AHCCCS Medicaid	$20,073.37
Rate for Payer: Allwell Medicaid	$20,073.37
Rate for Payer: AZCH Complete Medicaid	$20,073.37
Rate for Payer: Banner UC Health Medicaid	$20,073.37
Rate for Payer: Mercy Care Medicaid	$20,073.37

Head Trauma With Coma > 1 Hour Or Hemorrhage

Facility

IP

$9,925.51

Service Code	APR-DRG 0553
Hospital Charge Code	APRDRG0554
Min. Negotiated Rate	$9,925.51
Max. Negotiated Rate	$9,925.51
Rate for Payer: AHCCCS Medicaid	$9,925.51
Rate for Payer: Allwell Medicaid	$9,925.51
Rate for Payer: AZCH Complete Medicaid	$9,925.51
Rate for Payer: Banner UC Health Medicaid	$9,925.51
Rate for Payer: Mercy Care Medicaid	$9,925.51

Heart And/Or Lung Transplant

Facility

IP

$61,900.65

Service Code	APR-DRG 0021
Hospital Charge Code	APRDRG0024
Min. Negotiated Rate	$61,900.65
Max. Negotiated Rate	$61,900.65
Rate for Payer: AHCCCS Medicaid	$61,900.65
Rate for Payer: Allwell Medicaid	$61,900.65
Rate for Payer: AZCH Complete Medicaid	$61,900.65
Rate for Payer: Banner UC Health Medicaid	$61,900.65
Rate for Payer: Mercy Care Medicaid	$61,900.65

Heart And/Or Lung Transplant

Facility

IP

$181,701.18

Service Code	APR-DRG 0024
Hospital Charge Code	APRDRG0022
Min. Negotiated Rate	$181,701.18
Max. Negotiated Rate	$181,701.18
Rate for Payer: AHCCCS Medicaid	$181,701.18
Rate for Payer: Allwell Medicaid	$181,701.18
Rate for Payer: AZCH Complete Medicaid	$181,701.18
Rate for Payer: Banner UC Health Medicaid	$181,701.18
Rate for Payer: Mercy Care Medicaid	$181,701.18

Heart And/Or Lung Transplant

Facility

IP

$95,511.04

Service Code	APR-DRG 0023
Hospital Charge Code	APRDRG0021
Min. Negotiated Rate	$95,511.04
Max. Negotiated Rate	$95,511.04
Rate for Payer: AHCCCS Medicaid	$95,511.04
Rate for Payer: Allwell Medicaid	$95,511.04
Rate for Payer: AZCH Complete Medicaid	$95,511.04
Rate for Payer: Banner UC Health Medicaid	$95,511.04
Rate for Payer: Mercy Care Medicaid	$95,511.04

Heart And/Or Lung Transplant

Facility

IP

$80,073.23

Service Code	APR-DRG 0022
Hospital Charge Code	APRDRG0023
Min. Negotiated Rate	$80,073.23
Max. Negotiated Rate	$80,073.23
Rate for Payer: AHCCCS Medicaid	$80,073.23
Rate for Payer: Allwell Medicaid	$80,073.23
Rate for Payer: AZCH Complete Medicaid	$80,073.23
Rate for Payer: Banner UC Health Medicaid	$80,073.23
Rate for Payer: Mercy Care Medicaid	$80,073.23

Heart And/Or Lung Transplant

Facility

IP

$181,701.18

Service Code	APR-DRG 0024
Hospital Charge Code	APRDRG0023
Min. Negotiated Rate	$181,701.18
Max. Negotiated Rate	$181,701.18
Rate for Payer: AHCCCS Medicaid	$181,701.18
Rate for Payer: Allwell Medicaid	$181,701.18
Rate for Payer: AZCH Complete Medicaid	$181,701.18
Rate for Payer: Banner UC Health Medicaid	$181,701.18
Rate for Payer: Mercy Care Medicaid	$181,701.18

Heart And/Or Lung Transplant

Facility

IP

$61,900.65

Service Code	APR-DRG 0021
Hospital Charge Code	APRDRG0023
Min. Negotiated Rate	$61,900.65
Max. Negotiated Rate	$61,900.65
Rate for Payer: AHCCCS Medicaid	$61,900.65
Rate for Payer: Allwell Medicaid	$61,900.65
Rate for Payer: AZCH Complete Medicaid	$61,900.65
Rate for Payer: Banner UC Health Medicaid	$61,900.65
Rate for Payer: Mercy Care Medicaid	$61,900.65

Heart And/Or Lung Transplant

Facility

IP

$95,511.04

Service Code	APR-DRG 0023
Hospital Charge Code	APRDRG0024
Min. Negotiated Rate	$95,511.04
Max. Negotiated Rate	$95,511.04
Rate for Payer: AHCCCS Medicaid	$95,511.04
Rate for Payer: Allwell Medicaid	$95,511.04
Rate for Payer: AZCH Complete Medicaid	$95,511.04
Rate for Payer: Banner UC Health Medicaid	$95,511.04
Rate for Payer: Mercy Care Medicaid	$95,511.04

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