Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

INSERTION OF STOMACH TUBE USING AN ENDOSCOPE

Facility

OP

$6,347.00

Service Code	CPT 43246
Hospital Charge Code	23598981
Hospital Revenue Code	750
Min. Negotiated Rate	$1,015.52
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Aetna of AZ Medicare	$1,777.16
Rate for Payer: AHCCCS Medicaid	$1,178.14
Rate for Payer: Allwell Medicaid	$1,178.14
Rate for Payer: Allwell Medicare	$1,015.52
Rate for Payer: Amerigroup Medicare	$1,015.52
Rate for Payer: APIPA Medicare/Medicaid	$2,370.60
Rate for Payer: AZCH Complete Medicaid	$1,178.14
Rate for Payer: AZCH Complete Medicare	$1,015.52
Rate for Payer: Banner UC Health Medicaid	$1,178.14
Rate for Payer: Banner UC Health Medicare	$1,015.52
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,315.96
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Cigna of AZ Commercial	$4,442.90
Rate for Payer: Copperpoint Commercial	$1,570.88
Rate for Payer: Health Net of AZ Commercial	$3,808.20
Rate for Payer: Health Net of AZ Medicare	$1,777.16
Rate for Payer: Humana of AZ Medicare	$1,015.52
Rate for Payer: Mercy Care Medicaid	$1,178.14
Rate for Payer: Self Pay Self Pay	$5,077.60
Rate for Payer: TriWest Medicare	$1,015.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,142.46

INSERTION OF STOMACH TUBE USING AN ENDOSCOPE

Facility

IP

$6,347.00

Service Code	CPT 43246
Hospital Charge Code	23598981
Hospital Revenue Code	750
Min. Negotiated Rate	$1,650.22
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Self Pay Self Pay	$5,077.60

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$13,891.93

Service Code	APR-DRG 1762
Hospital Charge Code	APRDRG1761
Min. Negotiated Rate	$13,891.93
Max. Negotiated Rate	$13,891.93
Rate for Payer: AHCCCS Medicaid	$13,891.93
Rate for Payer: Allwell Medicaid	$13,891.93
Rate for Payer: AZCH Complete Medicaid	$13,891.93
Rate for Payer: Banner UC Health Medicaid	$13,891.93
Rate for Payer: Mercy Care Medicaid	$13,891.93

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$21,407.43

Service Code	APR-DRG 1763
Hospital Charge Code	APRDRG1762
Min. Negotiated Rate	$21,407.43
Max. Negotiated Rate	$21,407.43
Rate for Payer: AHCCCS Medicaid	$21,407.43
Rate for Payer: Allwell Medicaid	$21,407.43
Rate for Payer: AZCH Complete Medicaid	$21,407.43
Rate for Payer: Banner UC Health Medicaid	$21,407.43
Rate for Payer: Mercy Care Medicaid	$21,407.43

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$13,891.93

Service Code	APR-DRG 1762
Hospital Charge Code	APRDRG1764
Min. Negotiated Rate	$13,891.93
Max. Negotiated Rate	$13,891.93
Rate for Payer: AHCCCS Medicaid	$13,891.93
Rate for Payer: Allwell Medicaid	$13,891.93
Rate for Payer: AZCH Complete Medicaid	$13,891.93
Rate for Payer: Banner UC Health Medicaid	$13,891.93
Rate for Payer: Mercy Care Medicaid	$13,891.93

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$11,330.42

Service Code	APR-DRG 1761
Hospital Charge Code	APRDRG1762
Min. Negotiated Rate	$11,330.42
Max. Negotiated Rate	$11,330.42
Rate for Payer: AHCCCS Medicaid	$11,330.42
Rate for Payer: Allwell Medicaid	$11,330.42
Rate for Payer: AZCH Complete Medicaid	$11,330.42
Rate for Payer: Banner UC Health Medicaid	$11,330.42
Rate for Payer: Mercy Care Medicaid	$11,330.42

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$21,407.43

Service Code	APR-DRG 1763
Hospital Charge Code	APRDRG1763
Min. Negotiated Rate	$21,407.43
Max. Negotiated Rate	$21,407.43
Rate for Payer: AHCCCS Medicaid	$21,407.43
Rate for Payer: Allwell Medicaid	$21,407.43
Rate for Payer: AZCH Complete Medicaid	$21,407.43
Rate for Payer: Banner UC Health Medicaid	$21,407.43
Rate for Payer: Mercy Care Medicaid	$21,407.43

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$21,407.43

Service Code	APR-DRG 1763
Hospital Charge Code	APRDRG1761
Min. Negotiated Rate	$21,407.43
Max. Negotiated Rate	$21,407.43
Rate for Payer: AHCCCS Medicaid	$21,407.43
Rate for Payer: Allwell Medicaid	$21,407.43
Rate for Payer: AZCH Complete Medicaid	$21,407.43
Rate for Payer: Banner UC Health Medicaid	$21,407.43
Rate for Payer: Mercy Care Medicaid	$21,407.43

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$21,407.43

Service Code	APR-DRG 1763
Hospital Charge Code	APRDRG1764
Min. Negotiated Rate	$21,407.43
Max. Negotiated Rate	$21,407.43
Rate for Payer: AHCCCS Medicaid	$21,407.43
Rate for Payer: Allwell Medicaid	$21,407.43
Rate for Payer: AZCH Complete Medicaid	$21,407.43
Rate for Payer: Banner UC Health Medicaid	$21,407.43
Rate for Payer: Mercy Care Medicaid	$21,407.43

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$36,653.06

Service Code	APR-DRG 1764
Hospital Charge Code	APRDRG1764
Min. Negotiated Rate	$36,653.06
Max. Negotiated Rate	$36,653.06
Rate for Payer: AHCCCS Medicaid	$36,653.06
Rate for Payer: Allwell Medicaid	$36,653.06
Rate for Payer: AZCH Complete Medicaid	$36,653.06
Rate for Payer: Banner UC Health Medicaid	$36,653.06
Rate for Payer: Mercy Care Medicaid	$36,653.06

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$36,653.06

Service Code	APR-DRG 1764
Hospital Charge Code	APRDRG1763
Min. Negotiated Rate	$36,653.06
Max. Negotiated Rate	$36,653.06
Rate for Payer: AHCCCS Medicaid	$36,653.06
Rate for Payer: Allwell Medicaid	$36,653.06
Rate for Payer: AZCH Complete Medicaid	$36,653.06
Rate for Payer: Banner UC Health Medicaid	$36,653.06
Rate for Payer: Mercy Care Medicaid	$36,653.06

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$36,653.06

Service Code	APR-DRG 1764
Hospital Charge Code	APRDRG1762
Min. Negotiated Rate	$36,653.06
Max. Negotiated Rate	$36,653.06
Rate for Payer: AHCCCS Medicaid	$36,653.06
Rate for Payer: Allwell Medicaid	$36,653.06
Rate for Payer: AZCH Complete Medicaid	$36,653.06
Rate for Payer: Banner UC Health Medicaid	$36,653.06
Rate for Payer: Mercy Care Medicaid	$36,653.06

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$11,330.42

Service Code	APR-DRG 1761
Hospital Charge Code	APRDRG1763
Min. Negotiated Rate	$11,330.42
Max. Negotiated Rate	$11,330.42
Rate for Payer: AHCCCS Medicaid	$11,330.42
Rate for Payer: Allwell Medicaid	$11,330.42
Rate for Payer: AZCH Complete Medicaid	$11,330.42
Rate for Payer: Banner UC Health Medicaid	$11,330.42
Rate for Payer: Mercy Care Medicaid	$11,330.42

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$36,653.06

Service Code	APR-DRG 1764
Hospital Charge Code	APRDRG1761
Min. Negotiated Rate	$36,653.06
Max. Negotiated Rate	$36,653.06
Rate for Payer: AHCCCS Medicaid	$36,653.06
Rate for Payer: Allwell Medicaid	$36,653.06
Rate for Payer: AZCH Complete Medicaid	$36,653.06
Rate for Payer: Banner UC Health Medicaid	$36,653.06
Rate for Payer: Mercy Care Medicaid	$36,653.06

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$13,891.93

Service Code	APR-DRG 1762
Hospital Charge Code	APRDRG1763
Min. Negotiated Rate	$13,891.93
Max. Negotiated Rate	$13,891.93
Rate for Payer: AHCCCS Medicaid	$13,891.93
Rate for Payer: Allwell Medicaid	$13,891.93
Rate for Payer: AZCH Complete Medicaid	$13,891.93
Rate for Payer: Banner UC Health Medicaid	$13,891.93
Rate for Payer: Mercy Care Medicaid	$13,891.93

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$11,330.42

Service Code	APR-DRG 1761
Hospital Charge Code	APRDRG1761
Min. Negotiated Rate	$11,330.42
Max. Negotiated Rate	$11,330.42
Rate for Payer: AHCCCS Medicaid	$11,330.42
Rate for Payer: Allwell Medicaid	$11,330.42
Rate for Payer: AZCH Complete Medicaid	$11,330.42
Rate for Payer: Banner UC Health Medicaid	$11,330.42
Rate for Payer: Mercy Care Medicaid	$11,330.42

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$11,330.42

Service Code	APR-DRG 1761
Hospital Charge Code	APRDRG1764
Min. Negotiated Rate	$11,330.42
Max. Negotiated Rate	$11,330.42
Rate for Payer: AHCCCS Medicaid	$11,330.42
Rate for Payer: Allwell Medicaid	$11,330.42
Rate for Payer: AZCH Complete Medicaid	$11,330.42
Rate for Payer: Banner UC Health Medicaid	$11,330.42
Rate for Payer: Mercy Care Medicaid	$11,330.42

Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices

Facility

IP

$13,891.93

Service Code	APR-DRG 1762
Hospital Charge Code	APRDRG1762
Min. Negotiated Rate	$13,891.93
Max. Negotiated Rate	$13,891.93
Rate for Payer: AHCCCS Medicaid	$13,891.93
Rate for Payer: Allwell Medicaid	$13,891.93
Rate for Payer: AZCH Complete Medicaid	$13,891.93
Rate for Payer: Banner UC Health Medicaid	$13,891.93
Rate for Payer: Mercy Care Medicaid	$13,891.93

INSITU HYBRIDIZATION AUTO

Facility

IP

$1,026.00

Service Code	CPT 88367
Hospital Charge Code	22545746
Hospital Revenue Code	310
Min. Negotiated Rate	$266.76
Max. Negotiated Rate	$923.40
Rate for Payer: Aetna of AZ Commercial	$923.40
Rate for Payer: Bisbee Police All Plans	$266.76
Rate for Payer: Cash Price	$820.80
Rate for Payer: Self Pay Self Pay	$820.80

INSITU HYBRIDIZATION AUTO

Facility

OP

$1,026.00

Service Code	CPT 88367
Hospital Charge Code	22545746
Hospital Revenue Code	310
Min. Negotiated Rate	$164.16
Max. Negotiated Rate	$923.40
Rate for Payer: Aetna of AZ Commercial	$923.40
Rate for Payer: Aetna of AZ Medicare	$287.28
Rate for Payer: Allwell Medicare	$164.16
Rate for Payer: Amerigroup Medicare	$164.16
Rate for Payer: APIPA Medicare/Medicaid	$383.21
Rate for Payer: AZCH Complete Medicare	$164.16
Rate for Payer: Banner UC Health Medicare	$164.16
Rate for Payer: Bisbee Police All Plans	$266.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$697.68
Rate for Payer: Cash Price	$820.80
Rate for Payer: Cigna of AZ Commercial	$666.90
Rate for Payer: Copperpoint Commercial	$253.94
Rate for Payer: Health Net of AZ Commercial	$615.60
Rate for Payer: Health Net of AZ Medicare	$287.28
Rate for Payer: Humana of AZ Medicare	$164.16
Rate for Payer: Self Pay Self Pay	$820.80
Rate for Payer: TriWest Medicare	$164.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$598.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$184.68

INSITU HYBRIDIZATION (FISH)

Facility

IP

$623.00

Service Code	CPT 88365
Hospital Charge Code	22545743
Hospital Revenue Code	310
Min. Negotiated Rate	$161.98
Max. Negotiated Rate	$560.70
Rate for Payer: Aetna of AZ Commercial	$560.70
Rate for Payer: Bisbee Police All Plans	$161.98
Rate for Payer: Cash Price	$498.40
Rate for Payer: Self Pay Self Pay	$498.40

INSITU HYBRIDIZATION (FISH)

Facility

OP

$623.00

Service Code	CPT 88365
Hospital Charge Code	22545743
Hospital Revenue Code	310
Min. Negotiated Rate	$99.68
Max. Negotiated Rate	$560.70
Rate for Payer: Aetna of AZ Commercial	$560.70
Rate for Payer: Aetna of AZ Medicare	$174.44
Rate for Payer: Allwell Medicare	$99.68
Rate for Payer: Amerigroup Medicare	$99.68
Rate for Payer: APIPA Medicare/Medicaid	$232.69
Rate for Payer: AZCH Complete Medicare	$99.68
Rate for Payer: Banner UC Health Medicare	$99.68
Rate for Payer: Bisbee Police All Plans	$161.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$423.64
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cigna of AZ Commercial	$404.95
Rate for Payer: Copperpoint Commercial	$154.19
Rate for Payer: Health Net of AZ Commercial	$373.80
Rate for Payer: Health Net of AZ Medicare	$174.44
Rate for Payer: Humana of AZ Medicare	$99.68
Rate for Payer: Self Pay Self Pay	$498.40
Rate for Payer: TriWest Medicare	$99.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$363.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$112.14

INSITU HYBRIDIZATION MANUAL

Facility

OP

$935.00

Service Code	CPT 88368
Hospital Charge Code	22545747
Hospital Revenue Code	310
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Aetna of AZ Medicare	$261.80
Rate for Payer: Allwell Medicare	$149.60
Rate for Payer: Amerigroup Medicare	$149.60
Rate for Payer: APIPA Medicare/Medicaid	$349.22
Rate for Payer: AZCH Complete Medicare	$149.60
Rate for Payer: Banner UC Health Medicare	$149.60
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$635.80
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cigna of AZ Commercial	$607.75
Rate for Payer: Copperpoint Commercial	$231.41
Rate for Payer: Health Net of AZ Commercial	$561.00
Rate for Payer: Health Net of AZ Medicare	$261.80
Rate for Payer: Humana of AZ Medicare	$149.60
Rate for Payer: Self Pay Self Pay	$748.00
Rate for Payer: TriWest Medicare	$149.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$545.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$168.30

INSITU HYBRIDIZATION MANUAL

Facility

IP

$935.00

Service Code	CPT 88368
Hospital Charge Code	22545747
Hospital Revenue Code	310
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna of AZ Commercial	$841.50
Rate for Payer: Bisbee Police All Plans	$243.10
Rate for Payer: Cash Price	$748.00
Rate for Payer: Self Pay Self Pay	$748.00

INSORB STAPLER

Facility

IP

$121.00

Hospital Charge Code	22598339
Hospital Revenue Code	272
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Cash Price	$96.80
Rate for Payer: Self Pay Self Pay	$96.80

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