Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$3,979.74

Service Code	APR-DRG 8941
Hospital Charge Code	APRDRG8941
Min. Negotiated Rate	$3,979.74
Max. Negotiated Rate	$3,979.74
Rate for Payer: AHCCCS Medicaid	$3,979.74
Rate for Payer: Allwell Medicaid	$3,979.74
Rate for Payer: AZCH Complete Medicaid	$3,979.74
Rate for Payer: Banner UC Health Medicaid	$3,979.74
Rate for Payer: Mercy Care Medicaid	$3,979.74

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$5,054.99

Service Code	APR-DRG 8942
Hospital Charge Code	APRDRG8941
Min. Negotiated Rate	$5,054.99
Max. Negotiated Rate	$5,054.99
Rate for Payer: AHCCCS Medicaid	$5,054.99
Rate for Payer: Allwell Medicaid	$5,054.99
Rate for Payer: AZCH Complete Medicaid	$5,054.99
Rate for Payer: Banner UC Health Medicaid	$5,054.99
Rate for Payer: Mercy Care Medicaid	$5,054.99

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$3,979.74

Service Code	APR-DRG 8941
Hospital Charge Code	APRDRG8943
Min. Negotiated Rate	$3,979.74
Max. Negotiated Rate	$3,979.74
Rate for Payer: AHCCCS Medicaid	$3,979.74
Rate for Payer: Allwell Medicaid	$3,979.74
Rate for Payer: AZCH Complete Medicaid	$3,979.74
Rate for Payer: Banner UC Health Medicaid	$3,979.74
Rate for Payer: Mercy Care Medicaid	$3,979.74

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$3,979.74

Service Code	APR-DRG 8941
Hospital Charge Code	APRDRG8944
Min. Negotiated Rate	$3,979.74
Max. Negotiated Rate	$3,979.74
Rate for Payer: AHCCCS Medicaid	$3,979.74
Rate for Payer: Allwell Medicaid	$3,979.74
Rate for Payer: AZCH Complete Medicaid	$3,979.74
Rate for Payer: Banner UC Health Medicaid	$3,979.74
Rate for Payer: Mercy Care Medicaid	$3,979.74

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$5,054.99

Service Code	APR-DRG 8942
Hospital Charge Code	APRDRG8943
Min. Negotiated Rate	$5,054.99
Max. Negotiated Rate	$5,054.99
Rate for Payer: AHCCCS Medicaid	$5,054.99
Rate for Payer: Allwell Medicaid	$5,054.99
Rate for Payer: AZCH Complete Medicaid	$5,054.99
Rate for Payer: Banner UC Health Medicaid	$5,054.99
Rate for Payer: Mercy Care Medicaid	$5,054.99

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$10,390.54

Service Code	APR-DRG 8944
Hospital Charge Code	APRDRG8942
Min. Negotiated Rate	$10,390.54
Max. Negotiated Rate	$10,390.54
Rate for Payer: AHCCCS Medicaid	$10,390.54
Rate for Payer: Allwell Medicaid	$10,390.54
Rate for Payer: AZCH Complete Medicaid	$10,390.54
Rate for Payer: Banner UC Health Medicaid	$10,390.54
Rate for Payer: Mercy Care Medicaid	$10,390.54

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$10,390.54

Service Code	APR-DRG 8944
Hospital Charge Code	APRDRG8941
Min. Negotiated Rate	$10,390.54
Max. Negotiated Rate	$10,390.54
Rate for Payer: AHCCCS Medicaid	$10,390.54
Rate for Payer: Allwell Medicaid	$10,390.54
Rate for Payer: AZCH Complete Medicaid	$10,390.54
Rate for Payer: Banner UC Health Medicaid	$10,390.54
Rate for Payer: Mercy Care Medicaid	$10,390.54

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$10,390.54

Service Code	APR-DRG 8944
Hospital Charge Code	APRDRG8943
Min. Negotiated Rate	$10,390.54
Max. Negotiated Rate	$10,390.54
Rate for Payer: AHCCCS Medicaid	$10,390.54
Rate for Payer: Allwell Medicaid	$10,390.54
Rate for Payer: AZCH Complete Medicaid	$10,390.54
Rate for Payer: Banner UC Health Medicaid	$10,390.54
Rate for Payer: Mercy Care Medicaid	$10,390.54

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$6,836.55

Service Code	APR-DRG 8943
Hospital Charge Code	APRDRG8944
Min. Negotiated Rate	$6,836.55
Max. Negotiated Rate	$6,836.55
Rate for Payer: AHCCCS Medicaid	$6,836.55
Rate for Payer: Allwell Medicaid	$6,836.55
Rate for Payer: AZCH Complete Medicaid	$6,836.55
Rate for Payer: Banner UC Health Medicaid	$6,836.55
Rate for Payer: Mercy Care Medicaid	$6,836.55

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$3,979.74

Service Code	APR-DRG 8941
Hospital Charge Code	APRDRG8942
Min. Negotiated Rate	$3,979.74
Max. Negotiated Rate	$3,979.74
Rate for Payer: AHCCCS Medicaid	$3,979.74
Rate for Payer: Allwell Medicaid	$3,979.74
Rate for Payer: AZCH Complete Medicaid	$3,979.74
Rate for Payer: Banner UC Health Medicaid	$3,979.74
Rate for Payer: Mercy Care Medicaid	$3,979.74

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$6,836.55

Service Code	APR-DRG 8943
Hospital Charge Code	APRDRG8943
Min. Negotiated Rate	$6,836.55
Max. Negotiated Rate	$6,836.55
Rate for Payer: AHCCCS Medicaid	$6,836.55
Rate for Payer: Allwell Medicaid	$6,836.55
Rate for Payer: AZCH Complete Medicaid	$6,836.55
Rate for Payer: Banner UC Health Medicaid	$6,836.55
Rate for Payer: Mercy Care Medicaid	$6,836.55

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$5,054.99

Service Code	APR-DRG 8942
Hospital Charge Code	APRDRG8944
Min. Negotiated Rate	$5,054.99
Max. Negotiated Rate	$5,054.99
Rate for Payer: AHCCCS Medicaid	$5,054.99
Rate for Payer: Allwell Medicaid	$5,054.99
Rate for Payer: AZCH Complete Medicaid	$5,054.99
Rate for Payer: Banner UC Health Medicaid	$5,054.99
Rate for Payer: Mercy Care Medicaid	$5,054.99

Hiv With One Significant Hiv Condition Or Without Significant Related Conditions

Facility

IP

$10,390.54

Service Code	APR-DRG 8944
Hospital Charge Code	APRDRG8944
Min. Negotiated Rate	$10,390.54
Max. Negotiated Rate	$10,390.54
Rate for Payer: AHCCCS Medicaid	$10,390.54
Rate for Payer: Allwell Medicaid	$10,390.54
Rate for Payer: AZCH Complete Medicaid	$10,390.54
Rate for Payer: Banner UC Health Medicaid	$10,390.54
Rate for Payer: Mercy Care Medicaid	$10,390.54

HLA B 27 Disease Association LC

Facility

IP

$340.00

Service Code	CPT 86812
Hospital Charge Code	1906894
Hospital Revenue Code	302
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Bisbee Police All Plans	$88.40
Rate for Payer: Cash Price	$272.00
Rate for Payer: Self Pay Self Pay	$272.00

HLA B 27 Disease Association LC

Facility

OP

$340.00

Service Code	CPT 86812
Hospital Charge Code	1906894
Hospital Revenue Code	302
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna of AZ Commercial	$306.00
Rate for Payer: Aetna of AZ Medicare	$95.20
Rate for Payer: Allwell Medicare	$54.40
Rate for Payer: Amerigroup Medicare	$54.40
Rate for Payer: APIPA Medicare/Medicaid	$126.99
Rate for Payer: AZCH Complete Medicare	$54.40
Rate for Payer: Banner UC Health Medicare	$54.40
Rate for Payer: Bisbee Police All Plans	$88.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$231.20
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cigna of AZ Commercial	$221.00
Rate for Payer: Copperpoint Commercial	$84.15
Rate for Payer: Health Net of AZ Commercial	$204.00
Rate for Payer: Health Net of AZ Medicare	$95.20
Rate for Payer: Humana of AZ Medicare	$54.40
Rate for Payer: Self Pay Self Pay	$272.00
Rate for Payer: TriWest Medicare	$54.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$198.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.20

HLA B5701 Test LC

Facility

OP

$2,217.00

Service Code	CPT 81381
Hospital Charge Code	22311194
Hospital Revenue Code	301
Min. Negotiated Rate	$354.72
Max. Negotiated Rate	$1,995.30
Rate for Payer: Aetna of AZ Commercial	$1,995.30
Rate for Payer: Aetna of AZ Medicare	$620.76
Rate for Payer: Allwell Medicare	$354.72
Rate for Payer: Amerigroup Medicare	$354.72
Rate for Payer: APIPA Medicare/Medicaid	$828.05
Rate for Payer: AZCH Complete Medicare	$354.72
Rate for Payer: Banner UC Health Medicare	$354.72
Rate for Payer: Bisbee Police All Plans	$576.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,507.56
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cigna of AZ Commercial	$1,441.05
Rate for Payer: Copperpoint Commercial	$548.71
Rate for Payer: Health Net of AZ Commercial	$1,330.20
Rate for Payer: Health Net of AZ Medicare	$620.76
Rate for Payer: Humana of AZ Medicare	$354.72
Rate for Payer: Self Pay Self Pay	$1,773.60
Rate for Payer: TriWest Medicare	$354.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,292.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$399.06

HLA B5701 Test LC

Facility

IP

$2,217.00

Service Code	CPT 81381
Hospital Charge Code	22311194
Hospital Revenue Code	301
Min. Negotiated Rate	$576.42
Max. Negotiated Rate	$1,995.30
Rate for Payer: Aetna of AZ Commercial	$1,995.30
Rate for Payer: Bisbee Police All Plans	$576.42
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Self Pay Self Pay	$1,773.60

HOLDER ENDO NEOFIT

Facility

IP

$102.00

Hospital Charge Code	22926451
Hospital Revenue Code	272
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Cash Price	$81.60
Rate for Payer: Self Pay Self Pay	$81.60

HOLDER ENDO NEOFIT

Facility

OP

$102.00

Hospital Charge Code	22926451
Hospital Revenue Code	272
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna of AZ Commercial	$91.80
Rate for Payer: Aetna of AZ Medicare	$28.56
Rate for Payer: Allwell Medicare	$16.32
Rate for Payer: Amerigroup Medicare	$16.32
Rate for Payer: APIPA Medicare/Medicaid	$38.10
Rate for Payer: AZCH Complete Medicare	$16.32
Rate for Payer: Banner UC Health Medicare	$16.32
Rate for Payer: Bisbee Police All Plans	$26.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$69.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cigna of AZ Commercial	$71.40
Rate for Payer: Copperpoint Commercial	$25.25
Rate for Payer: Health Net of AZ Commercial	$61.20
Rate for Payer: Health Net of AZ Medicare	$28.56
Rate for Payer: Humana of AZ Medicare	$16.32
Rate for Payer: Self Pay Self Pay	$81.60
Rate for Payer: TriWest Medicare	$16.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$59.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.36

Homocyst(e)ine, Plasma LC

Facility

OP

$485.00

Service Code	CPT 83090
Hospital Charge Code	1905630
Hospital Revenue Code	301
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Aetna of AZ Medicare	$135.80
Rate for Payer: Allwell Medicare	$77.60
Rate for Payer: Amerigroup Medicare	$77.60
Rate for Payer: APIPA Medicare/Medicaid	$181.15
Rate for Payer: AZCH Complete Medicare	$77.60
Rate for Payer: Banner UC Health Medicare	$77.60
Rate for Payer: Bisbee Police All Plans	$126.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$329.80
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cigna of AZ Commercial	$315.25
Rate for Payer: Copperpoint Commercial	$120.04
Rate for Payer: Health Net of AZ Commercial	$291.00
Rate for Payer: Health Net of AZ Medicare	$135.80
Rate for Payer: Humana of AZ Medicare	$77.60
Rate for Payer: Self Pay Self Pay	$388.00
Rate for Payer: TriWest Medicare	$77.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$282.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.30

Homocyst(e)ine, Plasma LC

Facility

IP

$485.00

Service Code	CPT 83090
Hospital Charge Code	1905630
Hospital Revenue Code	301
Min. Negotiated Rate	$126.10
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna of AZ Commercial	$436.50
Rate for Payer: Bisbee Police All Plans	$126.10
Rate for Payer: Cash Price	$388.00
Rate for Payer: Self Pay Self Pay	$388.00

Hospice / IP Respite

Facility

IP

$467.00

Hospital Charge Code	27621817
Hospital Revenue Code	301
Min. Negotiated Rate	$121.42
Max. Negotiated Rate	$420.30
Rate for Payer: Aetna of AZ Commercial	$420.30
Rate for Payer: Bisbee Police All Plans	$121.42
Rate for Payer: Cash Price	$373.60
Rate for Payer: Self Pay Self Pay	$373.60

Hospice / IP Respite

Facility

OP

$467.00

Hospital Charge Code	27621817
Hospital Revenue Code	301
Min. Negotiated Rate	$74.72
Max. Negotiated Rate	$420.30
Rate for Payer: Aetna of AZ Commercial	$420.30
Rate for Payer: Aetna of AZ Medicare	$130.76
Rate for Payer: Allwell Medicare	$74.72
Rate for Payer: Amerigroup Medicare	$74.72
Rate for Payer: APIPA Medicare/Medicaid	$174.42
Rate for Payer: AZCH Complete Medicare	$74.72
Rate for Payer: Banner UC Health Medicare	$74.72
Rate for Payer: Bisbee Police All Plans	$121.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$317.56
Rate for Payer: Cash Price	$373.60
Rate for Payer: Cigna of AZ Commercial	$303.55
Rate for Payer: Copperpoint Commercial	$115.58
Rate for Payer: Health Net of AZ Commercial	$280.20
Rate for Payer: Health Net of AZ Medicare	$130.76
Rate for Payer: Humana of AZ Medicare	$74.72
Rate for Payer: Self Pay Self Pay	$373.60
Rate for Payer: TriWest Medicare	$74.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$272.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$84.06

H Pylori AB IgM LC

Facility

IP

$216.00

Service Code	CPT 86677
Hospital Charge Code	3658178
Hospital Revenue Code	302
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Cash Price	$172.80
Rate for Payer: Self Pay Self Pay	$172.80

H Pylori AB IgM LC

Facility

OP

$216.00

Service Code	CPT 86677
Hospital Charge Code	3658178
Hospital Revenue Code	302
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Aetna of AZ Medicare	$60.48
Rate for Payer: Allwell Medicare	$34.56
Rate for Payer: Amerigroup Medicare	$34.56
Rate for Payer: APIPA Medicare/Medicaid	$80.68
Rate for Payer: AZCH Complete Medicare	$34.56
Rate for Payer: Banner UC Health Medicare	$34.56
Rate for Payer: Bisbee Police All Plans	$56.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.88
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$140.40
Rate for Payer: Copperpoint Commercial	$53.46
Rate for Payer: Health Net of AZ Commercial	$129.60
Rate for Payer: Health Net of AZ Medicare	$60.48
Rate for Payer: Humana of AZ Medicare	$34.56
Rate for Payer: Self Pay Self Pay	$172.80
Rate for Payer: TriWest Medicare	$34.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.93
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.88

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