Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Lower Extremity Arterial Procedures

Facility

IP

$22,058.33

Service Code	APR-DRG 1813
Hospital Charge Code	APRDRG1811
Min. Negotiated Rate	$22,058.33
Max. Negotiated Rate	$22,058.33
Rate for Payer: AHCCCS Medicaid	$22,058.33
Rate for Payer: Allwell Medicaid	$22,058.33
Rate for Payer: AZCH Complete Medicaid	$22,058.33
Rate for Payer: Banner UC Health Medicaid	$22,058.33
Rate for Payer: Mercy Care Medicaid	$22,058.33

Lower Extremity Arterial Procedures

Facility

IP

$22,058.33

Service Code	APR-DRG 1813
Hospital Charge Code	APRDRG1813
Min. Negotiated Rate	$22,058.33
Max. Negotiated Rate	$22,058.33
Rate for Payer: AHCCCS Medicaid	$22,058.33
Rate for Payer: Allwell Medicaid	$22,058.33
Rate for Payer: AZCH Complete Medicaid	$22,058.33
Rate for Payer: Banner UC Health Medicaid	$22,058.33
Rate for Payer: Mercy Care Medicaid	$22,058.33

Lower Extremity Arterial Procedures

Facility

IP

$37,239.43

Service Code	APR-DRG 1814
Hospital Charge Code	APRDRG1813
Min. Negotiated Rate	$37,239.43
Max. Negotiated Rate	$37,239.43
Rate for Payer: AHCCCS Medicaid	$37,239.43
Rate for Payer: Allwell Medicaid	$37,239.43
Rate for Payer: AZCH Complete Medicaid	$37,239.43
Rate for Payer: Banner UC Health Medicaid	$37,239.43
Rate for Payer: Mercy Care Medicaid	$37,239.43

Lower Extremity Arterial Procedures

Facility

IP

$13,613.47

Service Code	APR-DRG 1812
Hospital Charge Code	APRDRG1811
Min. Negotiated Rate	$13,613.47
Max. Negotiated Rate	$13,613.47
Rate for Payer: AHCCCS Medicaid	$13,613.47
Rate for Payer: Allwell Medicaid	$13,613.47
Rate for Payer: AZCH Complete Medicaid	$13,613.47
Rate for Payer: Banner UC Health Medicaid	$13,613.47
Rate for Payer: Mercy Care Medicaid	$13,613.47

Lower Extremity Arterial Procedures

Facility

IP

$37,239.43

Service Code	APR-DRG 1814
Hospital Charge Code	APRDRG1811
Min. Negotiated Rate	$37,239.43
Max. Negotiated Rate	$37,239.43
Rate for Payer: AHCCCS Medicaid	$37,239.43
Rate for Payer: Allwell Medicaid	$37,239.43
Rate for Payer: AZCH Complete Medicaid	$37,239.43
Rate for Payer: Banner UC Health Medicaid	$37,239.43
Rate for Payer: Mercy Care Medicaid	$37,239.43

Lower Extremity Arterial Procedures

Facility

IP

$22,058.33

Service Code	APR-DRG 1813
Hospital Charge Code	APRDRG1812
Min. Negotiated Rate	$22,058.33
Max. Negotiated Rate	$22,058.33
Rate for Payer: AHCCCS Medicaid	$22,058.33
Rate for Payer: Allwell Medicaid	$22,058.33
Rate for Payer: AZCH Complete Medicaid	$22,058.33
Rate for Payer: Banner UC Health Medicaid	$22,058.33
Rate for Payer: Mercy Care Medicaid	$22,058.33

Lower Extremity Arterial Procedures

Facility

IP

$9,384.03

Service Code	APR-DRG 1811
Hospital Charge Code	APRDRG1812
Min. Negotiated Rate	$9,384.03
Max. Negotiated Rate	$9,384.03
Rate for Payer: AHCCCS Medicaid	$9,384.03
Rate for Payer: Allwell Medicaid	$9,384.03
Rate for Payer: AZCH Complete Medicaid	$9,384.03
Rate for Payer: Banner UC Health Medicaid	$9,384.03
Rate for Payer: Mercy Care Medicaid	$9,384.03

Lower Extremity Arterial Procedures

Facility

IP

$13,613.47

Service Code	APR-DRG 1812
Hospital Charge Code	APRDRG1813
Min. Negotiated Rate	$13,613.47
Max. Negotiated Rate	$13,613.47
Rate for Payer: AHCCCS Medicaid	$13,613.47
Rate for Payer: Allwell Medicaid	$13,613.47
Rate for Payer: AZCH Complete Medicaid	$13,613.47
Rate for Payer: Banner UC Health Medicaid	$13,613.47
Rate for Payer: Mercy Care Medicaid	$13,613.47

Lower Extremity Arterial Procedures

Facility

IP

$13,613.47

Service Code	APR-DRG 1812
Hospital Charge Code	APRDRG1812
Min. Negotiated Rate	$13,613.47
Max. Negotiated Rate	$13,613.47
Rate for Payer: AHCCCS Medicaid	$13,613.47
Rate for Payer: Allwell Medicaid	$13,613.47
Rate for Payer: AZCH Complete Medicaid	$13,613.47
Rate for Payer: Banner UC Health Medicaid	$13,613.47
Rate for Payer: Mercy Care Medicaid	$13,613.47

Lower Extremity Arterial Procedures

Facility

IP

$22,058.33

Service Code	APR-DRG 1813
Hospital Charge Code	APRDRG1814
Min. Negotiated Rate	$22,058.33
Max. Negotiated Rate	$22,058.33
Rate for Payer: AHCCCS Medicaid	$22,058.33
Rate for Payer: Allwell Medicaid	$22,058.33
Rate for Payer: AZCH Complete Medicaid	$22,058.33
Rate for Payer: Banner UC Health Medicaid	$22,058.33
Rate for Payer: Mercy Care Medicaid	$22,058.33

Lower Extremity Arterial Procedures

Facility

IP

$37,239.43

Service Code	APR-DRG 1814
Hospital Charge Code	APRDRG1814
Min. Negotiated Rate	$37,239.43
Max. Negotiated Rate	$37,239.43
Rate for Payer: AHCCCS Medicaid	$37,239.43
Rate for Payer: Allwell Medicaid	$37,239.43
Rate for Payer: AZCH Complete Medicaid	$37,239.43
Rate for Payer: Banner UC Health Medicaid	$37,239.43
Rate for Payer: Mercy Care Medicaid	$37,239.43

Lower Extremity Arterial Procedures

Facility

IP

$9,384.03

Service Code	APR-DRG 1811
Hospital Charge Code	APRDRG1814
Min. Negotiated Rate	$9,384.03
Max. Negotiated Rate	$9,384.03
Rate for Payer: AHCCCS Medicaid	$9,384.03
Rate for Payer: Allwell Medicaid	$9,384.03
Rate for Payer: AZCH Complete Medicaid	$9,384.03
Rate for Payer: Banner UC Health Medicaid	$9,384.03
Rate for Payer: Mercy Care Medicaid	$9,384.03

Lower Extremity Arterial Procedures

Facility

IP

$37,239.43

Service Code	APR-DRG 1814
Hospital Charge Code	APRDRG1812
Min. Negotiated Rate	$37,239.43
Max. Negotiated Rate	$37,239.43
Rate for Payer: AHCCCS Medicaid	$37,239.43
Rate for Payer: Allwell Medicaid	$37,239.43
Rate for Payer: AZCH Complete Medicaid	$37,239.43
Rate for Payer: Banner UC Health Medicaid	$37,239.43
Rate for Payer: Mercy Care Medicaid	$37,239.43

Lp-PLA2 Activity

Facility

IP

$618.00

Service Code	CPT 81400
Hospital Charge Code	23092587
Hospital Revenue Code	301
Min. Negotiated Rate	$160.68
Max. Negotiated Rate	$556.20
Rate for Payer: Aetna of AZ Commercial	$556.20
Rate for Payer: Bisbee Police All Plans	$160.68
Rate for Payer: Cash Price	$494.40
Rate for Payer: Self Pay Self Pay	$494.40

Lp-PLA2 Activity

Facility

OP

$618.00

Service Code	CPT 81400
Hospital Charge Code	23092587
Hospital Revenue Code	301
Min. Negotiated Rate	$98.88
Max. Negotiated Rate	$556.20
Rate for Payer: Aetna of AZ Commercial	$556.20
Rate for Payer: Aetna of AZ Medicare	$173.04
Rate for Payer: Allwell Medicare	$98.88
Rate for Payer: Amerigroup Medicare	$98.88
Rate for Payer: APIPA Medicare/Medicaid	$230.82
Rate for Payer: AZCH Complete Medicare	$98.88
Rate for Payer: Banner UC Health Medicare	$98.88
Rate for Payer: Bisbee Police All Plans	$160.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$420.24
Rate for Payer: Cash Price	$494.40
Rate for Payer: Cigna of AZ Commercial	$401.70
Rate for Payer: Copperpoint Commercial	$152.96
Rate for Payer: Health Net of AZ Commercial	$370.80
Rate for Payer: Health Net of AZ Medicare	$173.04
Rate for Payer: Humana of AZ Medicare	$98.88
Rate for Payer: Self Pay Self Pay	$494.40
Rate for Payer: TriWest Medicare	$98.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$360.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$111.24

L/S supracerv hyst uter > 250G with USO/BSO

Facility

IP

$4,951.00

Service Code	CPT 58544
Hospital Charge Code	27267833
Hospital Revenue Code	360
Min. Negotiated Rate	$1,287.26
Max. Negotiated Rate	$4,455.90
Rate for Payer: Aetna of AZ Commercial	$4,455.90
Rate for Payer: Bisbee Police All Plans	$1,287.26
Rate for Payer: Cash Price	$3,960.80
Rate for Payer: Self Pay Self Pay	$3,960.80

L/S supracerv hyst uter > 250G with USO/BSO

Facility

OP

$4,951.00

Service Code	CPT 58544
Hospital Charge Code	27267833
Hospital Revenue Code	360
Min. Negotiated Rate	$792.16
Max. Negotiated Rate	$6,458.05
Rate for Payer: Aetna of AZ Commercial	$4,455.90
Rate for Payer: Aetna of AZ Medicare	$1,386.28
Rate for Payer: AHCCCS Medicaid	$6,458.05
Rate for Payer: Allwell Medicaid	$6,458.05
Rate for Payer: Allwell Medicare	$792.16
Rate for Payer: Amerigroup Medicare	$792.16
Rate for Payer: APIPA Medicare/Medicaid	$1,849.20
Rate for Payer: AZCH Complete Medicaid	$6,458.05
Rate for Payer: AZCH Complete Medicare	$792.16
Rate for Payer: Banner UC Health Medicaid	$6,458.05
Rate for Payer: Banner UC Health Medicare	$792.16
Rate for Payer: Bisbee Police All Plans	$1,287.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,366.68
Rate for Payer: Cash Price	$3,960.80
Rate for Payer: Cash Price	$3,960.80
Rate for Payer: Cigna of AZ Commercial	$2,475.50
Rate for Payer: Copperpoint Commercial	$1,225.37
Rate for Payer: Health Net of AZ Commercial	$2,970.60
Rate for Payer: Health Net of AZ Medicare	$1,386.28
Rate for Payer: Humana of AZ Medicare	$792.16
Rate for Payer: Mercy Care Medicaid	$6,458.05
Rate for Payer: Self Pay Self Pay	$3,960.80
Rate for Payer: TriWest Medicare	$792.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,886.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$891.18

L/S supracerv hyst uter < 250G w USO BSO

Facility

IP

$4,531.00

Service Code	CPT 58542
Hospital Charge Code	27291804
Hospital Revenue Code	360
Min. Negotiated Rate	$1,178.06
Max. Negotiated Rate	$4,077.90
Rate for Payer: Aetna of AZ Commercial	$4,077.90
Rate for Payer: Bisbee Police All Plans	$1,178.06
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Self Pay Self Pay	$3,624.80

L/S supracerv hyst uter < 250G w USO BSO

Facility

OP

$4,531.00

Service Code	CPT 58542
Hospital Charge Code	27291804
Hospital Revenue Code	360
Min. Negotiated Rate	$724.96
Max. Negotiated Rate	$6,458.05
Rate for Payer: Aetna of AZ Commercial	$4,077.90
Rate for Payer: Aetna of AZ Medicare	$1,268.68
Rate for Payer: AHCCCS Medicaid	$6,458.05
Rate for Payer: Allwell Medicaid	$6,458.05
Rate for Payer: Allwell Medicare	$724.96
Rate for Payer: Amerigroup Medicare	$724.96
Rate for Payer: APIPA Medicare/Medicaid	$1,692.33
Rate for Payer: AZCH Complete Medicaid	$6,458.05
Rate for Payer: AZCH Complete Medicare	$724.96
Rate for Payer: Banner UC Health Medicaid	$6,458.05
Rate for Payer: Banner UC Health Medicare	$724.96
Rate for Payer: Bisbee Police All Plans	$1,178.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,081.08
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Cash Price	$3,624.80
Rate for Payer: Cigna of AZ Commercial	$2,265.50
Rate for Payer: Copperpoint Commercial	$1,121.42
Rate for Payer: Health Net of AZ Commercial	$2,718.60
Rate for Payer: Health Net of AZ Medicare	$1,268.68
Rate for Payer: Humana of AZ Medicare	$724.96
Rate for Payer: Mercy Care Medicaid	$6,458.05
Rate for Payer: Self Pay Self Pay	$3,624.80
Rate for Payer: TriWest Medicare	$724.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,641.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$815.58

L/S supracervical hyst for uterus > 250g

Facility

OP

$4,380.00

Service Code	CPT 58543
Hospital Charge Code	27281900
Hospital Revenue Code	360
Min. Negotiated Rate	$700.80
Max. Negotiated Rate	$6,458.05
Rate for Payer: Aetna of AZ Commercial	$3,942.00
Rate for Payer: Aetna of AZ Medicare	$1,226.40
Rate for Payer: AHCCCS Medicaid	$6,458.05
Rate for Payer: Allwell Medicaid	$6,458.05
Rate for Payer: Allwell Medicare	$700.80
Rate for Payer: Amerigroup Medicare	$700.80
Rate for Payer: APIPA Medicare/Medicaid	$1,635.93
Rate for Payer: AZCH Complete Medicaid	$6,458.05
Rate for Payer: AZCH Complete Medicare	$700.80
Rate for Payer: Banner UC Health Medicaid	$6,458.05
Rate for Payer: Banner UC Health Medicare	$700.80
Rate for Payer: Bisbee Police All Plans	$1,138.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,978.40
Rate for Payer: Cash Price	$3,504.00
Rate for Payer: Cash Price	$3,504.00
Rate for Payer: Cigna of AZ Commercial	$2,190.00
Rate for Payer: Copperpoint Commercial	$1,084.05
Rate for Payer: Health Net of AZ Commercial	$2,628.00
Rate for Payer: Health Net of AZ Medicare	$1,226.40
Rate for Payer: Humana of AZ Medicare	$700.80
Rate for Payer: Mercy Care Medicaid	$6,458.05
Rate for Payer: Self Pay Self Pay	$3,504.00
Rate for Payer: TriWest Medicare	$700.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,553.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$788.40

L/S supracervical hyst for uterus > 250g

Facility

IP

$4,380.00

Service Code	CPT 58543
Hospital Charge Code	27281900
Hospital Revenue Code	360
Min. Negotiated Rate	$1,138.80
Max. Negotiated Rate	$3,942.00
Rate for Payer: Aetna of AZ Commercial	$3,942.00
Rate for Payer: Bisbee Police All Plans	$1,138.80
Rate for Payer: Cash Price	$3,504.00
Rate for Payer: Self Pay Self Pay	$3,504.00

Lupus Anticoagulant Comp LC

Facility

OP

$213.00

Service Code	CPT 85597
Hospital Charge Code	1285803
Hospital Revenue Code	301
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Aetna of AZ Medicare	$59.64
Rate for Payer: Allwell Medicare	$34.08
Rate for Payer: Amerigroup Medicare	$34.08
Rate for Payer: APIPA Medicare/Medicaid	$79.56
Rate for Payer: AZCH Complete Medicare	$34.08
Rate for Payer: Banner UC Health Medicare	$34.08
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.84
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$138.45
Rate for Payer: Copperpoint Commercial	$52.72
Rate for Payer: Health Net of AZ Commercial	$127.80
Rate for Payer: Health Net of AZ Medicare	$59.64
Rate for Payer: Humana of AZ Medicare	$34.08
Rate for Payer: Self Pay Self Pay	$170.40
Rate for Payer: TriWest Medicare	$34.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$124.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.34

Lupus Anticoagulant Comp LC

Facility

IP

$213.00

Service Code	CPT 85597
Hospital Charge Code	1285803
Hospital Revenue Code	301
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Cash Price	$170.40
Rate for Payer: Self Pay Self Pay	$170.40

Luteinizing Hormone(LH), S LC

Facility

IP

$492.00

Service Code	CPT 83002
Hospital Charge Code	2029219
Hospital Revenue Code	301
Min. Negotiated Rate	$127.92
Max. Negotiated Rate	$442.80
Rate for Payer: Aetna of AZ Commercial	$442.80
Rate for Payer: Bisbee Police All Plans	$127.92
Rate for Payer: Cash Price	$393.60
Rate for Payer: Self Pay Self Pay	$393.60

Luteinizing Hormone(LH), S LC

Facility

OP

$492.00

Service Code	CPT 83002
Hospital Charge Code	2029219
Hospital Revenue Code	301
Min. Negotiated Rate	$78.72
Max. Negotiated Rate	$442.80
Rate for Payer: Aetna of AZ Commercial	$442.80
Rate for Payer: Aetna of AZ Medicare	$137.76
Rate for Payer: Allwell Medicare	$78.72
Rate for Payer: Amerigroup Medicare	$78.72
Rate for Payer: APIPA Medicare/Medicaid	$183.76
Rate for Payer: AZCH Complete Medicare	$78.72
Rate for Payer: Banner UC Health Medicare	$78.72
Rate for Payer: Bisbee Police All Plans	$127.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$334.56
Rate for Payer: Cash Price	$393.60
Rate for Payer: Cigna of AZ Commercial	$319.80
Rate for Payer: Copperpoint Commercial	$121.77
Rate for Payer: Health Net of AZ Commercial	$295.20
Rate for Payer: Health Net of AZ Medicare	$137.76
Rate for Payer: Humana of AZ Medicare	$78.72
Rate for Payer: Self Pay Self Pay	$393.60
Rate for Payer: TriWest Medicare	$78.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$286.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.56

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