Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Lyme, IgM, Early Test/Reflex LC

Facility

OP

$352.00

Service Code	CPT 86618
Hospital Charge Code	22311198
Hospital Revenue Code	301
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$316.80
Rate for Payer: Aetna of AZ Commercial	$316.80
Rate for Payer: Aetna of AZ Medicare	$98.56
Rate for Payer: AHCCCS Medicaid	$17.03
Rate for Payer: Allwell Medicaid	$17.03
Rate for Payer: Allwell Medicare	$52.80
Rate for Payer: Amerigroup Medicare	$52.80
Rate for Payer: APIPA Medicare/Medicaid	$131.47
Rate for Payer: AZCH Complete Medicaid	$17.03
Rate for Payer: AZCH Complete Medicare	$52.80
Rate for Payer: Banner UC Health Medicaid	$17.03
Rate for Payer: Banner UC Health Medicare	$52.80
Rate for Payer: Bisbee Police All Plans	$91.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$239.36
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cigna of AZ Commercial	$228.80
Rate for Payer: Copperpoint Commercial	$87.12
Rate for Payer: Health Net of AZ Commercial	$211.20
Rate for Payer: Health Net of AZ Medicare	$98.56
Rate for Payer: Humana of AZ Medicare	$52.80
Rate for Payer: Mercy Care Medicaid	$17.03
Rate for Payer: Self Pay Self Pay	$281.60
Rate for Payer: TriWest Medicare	$52.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$205.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.36

Lyme, Western Blot, Serum LC

Facility

IP

$351.00

Service Code	CPT 86618
Hospital Charge Code	1285773
Hospital Revenue Code	302
Min. Negotiated Rate	$91.26
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of AZ Commercial	$315.90
Rate for Payer: Bisbee Police All Plans	$91.26
Rate for Payer: Cash Price	$280.80
Rate for Payer: Self Pay Self Pay	$280.80

Lyme, Western Blot, Serum LC

Facility

OP

$351.00

Service Code	CPT 86618
Hospital Charge Code	1285773
Hospital Revenue Code	302
Min. Negotiated Rate	$17.03
Max. Negotiated Rate	$315.90
Rate for Payer: Aetna of AZ Commercial	$315.90
Rate for Payer: Aetna of AZ Medicare	$98.28
Rate for Payer: AHCCCS Medicaid	$17.03
Rate for Payer: Allwell Medicaid	$17.03
Rate for Payer: Allwell Medicare	$52.65
Rate for Payer: Amerigroup Medicare	$52.65
Rate for Payer: APIPA Medicare/Medicaid	$131.10
Rate for Payer: AZCH Complete Medicaid	$17.03
Rate for Payer: AZCH Complete Medicare	$52.65
Rate for Payer: Banner UC Health Medicaid	$17.03
Rate for Payer: Banner UC Health Medicare	$52.65
Rate for Payer: Bisbee Police All Plans	$91.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$238.68
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna of AZ Commercial	$228.15
Rate for Payer: Copperpoint Commercial	$86.87
Rate for Payer: Health Net of AZ Commercial	$210.60
Rate for Payer: Health Net of AZ Medicare	$98.28
Rate for Payer: Humana of AZ Medicare	$52.65
Rate for Payer: Mercy Care Medicaid	$17.03
Rate for Payer: Self Pay Self Pay	$280.80
Rate for Payer: TriWest Medicare	$52.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$204.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$63.18

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$5,717.11

Service Code	APR-DRG 6942
Hospital Charge Code	APRDRG6944
Min. Negotiated Rate	$5,717.11
Max. Negotiated Rate	$5,717.11
Rate for Payer: AHCCCS Medicaid	$5,717.11
Rate for Payer: Allwell Medicaid	$5,717.11
Rate for Payer: AZCH Complete Medicaid	$5,717.11
Rate for Payer: Banner UC Health Medicaid	$5,717.11
Rate for Payer: Mercy Care Medicaid	$5,717.11

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$8,651.77

Service Code	APR-DRG 6943
Hospital Charge Code	APRDRG6942
Min. Negotiated Rate	$8,651.77
Max. Negotiated Rate	$8,651.77
Rate for Payer: AHCCCS Medicaid	$8,651.77
Rate for Payer: Allwell Medicaid	$8,651.77
Rate for Payer: AZCH Complete Medicaid	$8,651.77
Rate for Payer: Banner UC Health Medicaid	$8,651.77
Rate for Payer: Mercy Care Medicaid	$8,651.77

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$8,651.77

Service Code	APR-DRG 6943
Hospital Charge Code	APRDRG6943
Min. Negotiated Rate	$8,651.77
Max. Negotiated Rate	$8,651.77
Rate for Payer: AHCCCS Medicaid	$8,651.77
Rate for Payer: Allwell Medicaid	$8,651.77
Rate for Payer: AZCH Complete Medicaid	$8,651.77
Rate for Payer: Banner UC Health Medicaid	$8,651.77
Rate for Payer: Mercy Care Medicaid	$8,651.77

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$5,717.11

Service Code	APR-DRG 6942
Hospital Charge Code	APRDRG6943
Min. Negotiated Rate	$5,717.11
Max. Negotiated Rate	$5,717.11
Rate for Payer: AHCCCS Medicaid	$5,717.11
Rate for Payer: Allwell Medicaid	$5,717.11
Rate for Payer: AZCH Complete Medicaid	$5,717.11
Rate for Payer: Banner UC Health Medicaid	$5,717.11
Rate for Payer: Mercy Care Medicaid	$5,717.11

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$4,371.12

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG6944
Min. Negotiated Rate	$4,371.12
Max. Negotiated Rate	$4,371.12
Rate for Payer: AHCCCS Medicaid	$4,371.12
Rate for Payer: Allwell Medicaid	$4,371.12
Rate for Payer: AZCH Complete Medicaid	$4,371.12
Rate for Payer: Banner UC Health Medicaid	$4,371.12
Rate for Payer: Mercy Care Medicaid	$4,371.12

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$5,717.11

Service Code	APR-DRG 6942
Hospital Charge Code	APRDRG6942
Min. Negotiated Rate	$5,717.11
Max. Negotiated Rate	$5,717.11
Rate for Payer: AHCCCS Medicaid	$5,717.11
Rate for Payer: Allwell Medicaid	$5,717.11
Rate for Payer: AZCH Complete Medicaid	$5,717.11
Rate for Payer: Banner UC Health Medicaid	$5,717.11
Rate for Payer: Mercy Care Medicaid	$5,717.11

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$4,371.12

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG6941
Min. Negotiated Rate	$4,371.12
Max. Negotiated Rate	$4,371.12
Rate for Payer: AHCCCS Medicaid	$4,371.12
Rate for Payer: Allwell Medicaid	$4,371.12
Rate for Payer: AZCH Complete Medicaid	$4,371.12
Rate for Payer: Banner UC Health Medicaid	$4,371.12
Rate for Payer: Mercy Care Medicaid	$4,371.12

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$16,510.25

Service Code	APR-DRG 6944
Hospital Charge Code	APRDRG6943
Min. Negotiated Rate	$16,510.25
Max. Negotiated Rate	$16,510.25
Rate for Payer: AHCCCS Medicaid	$16,510.25
Rate for Payer: Allwell Medicaid	$16,510.25
Rate for Payer: AZCH Complete Medicaid	$16,510.25
Rate for Payer: Banner UC Health Medicaid	$16,510.25
Rate for Payer: Mercy Care Medicaid	$16,510.25

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$4,371.12

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG6943
Min. Negotiated Rate	$4,371.12
Max. Negotiated Rate	$4,371.12
Rate for Payer: AHCCCS Medicaid	$4,371.12
Rate for Payer: Allwell Medicaid	$4,371.12
Rate for Payer: AZCH Complete Medicaid	$4,371.12
Rate for Payer: Banner UC Health Medicaid	$4,371.12
Rate for Payer: Mercy Care Medicaid	$4,371.12

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$8,651.77

Service Code	APR-DRG 6943
Hospital Charge Code	APRDRG6944
Min. Negotiated Rate	$8,651.77
Max. Negotiated Rate	$8,651.77
Rate for Payer: AHCCCS Medicaid	$8,651.77
Rate for Payer: Allwell Medicaid	$8,651.77
Rate for Payer: AZCH Complete Medicaid	$8,651.77
Rate for Payer: Banner UC Health Medicaid	$8,651.77
Rate for Payer: Mercy Care Medicaid	$8,651.77

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$8,651.77

Service Code	APR-DRG 6943
Hospital Charge Code	APRDRG6941
Min. Negotiated Rate	$8,651.77
Max. Negotiated Rate	$8,651.77
Rate for Payer: AHCCCS Medicaid	$8,651.77
Rate for Payer: Allwell Medicaid	$8,651.77
Rate for Payer: AZCH Complete Medicaid	$8,651.77
Rate for Payer: Banner UC Health Medicaid	$8,651.77
Rate for Payer: Mercy Care Medicaid	$8,651.77

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$16,510.25

Service Code	APR-DRG 6944
Hospital Charge Code	APRDRG6942
Min. Negotiated Rate	$16,510.25
Max. Negotiated Rate	$16,510.25
Rate for Payer: AHCCCS Medicaid	$16,510.25
Rate for Payer: Allwell Medicaid	$16,510.25
Rate for Payer: AZCH Complete Medicaid	$16,510.25
Rate for Payer: Banner UC Health Medicaid	$16,510.25
Rate for Payer: Mercy Care Medicaid	$16,510.25

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$16,510.25

Service Code	APR-DRG 6944
Hospital Charge Code	APRDRG6944
Min. Negotiated Rate	$16,510.25
Max. Negotiated Rate	$16,510.25
Rate for Payer: AHCCCS Medicaid	$16,510.25
Rate for Payer: Allwell Medicaid	$16,510.25
Rate for Payer: AZCH Complete Medicaid	$16,510.25
Rate for Payer: Banner UC Health Medicaid	$16,510.25
Rate for Payer: Mercy Care Medicaid	$16,510.25

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$5,717.11

Service Code	APR-DRG 6942
Hospital Charge Code	APRDRG6941
Min. Negotiated Rate	$5,717.11
Max. Negotiated Rate	$5,717.11
Rate for Payer: AHCCCS Medicaid	$5,717.11
Rate for Payer: Allwell Medicaid	$5,717.11
Rate for Payer: AZCH Complete Medicaid	$5,717.11
Rate for Payer: Banner UC Health Medicaid	$5,717.11
Rate for Payer: Mercy Care Medicaid	$5,717.11

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$16,510.25

Service Code	APR-DRG 6944
Hospital Charge Code	APRDRG6941
Min. Negotiated Rate	$16,510.25
Max. Negotiated Rate	$16,510.25
Rate for Payer: AHCCCS Medicaid	$16,510.25
Rate for Payer: Allwell Medicaid	$16,510.25
Rate for Payer: AZCH Complete Medicaid	$16,510.25
Rate for Payer: Banner UC Health Medicaid	$16,510.25
Rate for Payer: Mercy Care Medicaid	$16,510.25

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$4,371.12

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG6942
Min. Negotiated Rate	$4,371.12
Max. Negotiated Rate	$4,371.12
Rate for Payer: AHCCCS Medicaid	$4,371.12
Rate for Payer: Allwell Medicaid	$4,371.12
Rate for Payer: AZCH Complete Medicaid	$4,371.12
Rate for Payer: Banner UC Health Medicaid	$4,371.12
Rate for Payer: Mercy Care Medicaid	$4,371.12

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$13,707.46

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG6911
Min. Negotiated Rate	$13,707.46
Max. Negotiated Rate	$13,707.46
Rate for Payer: AHCCCS Medicaid	$13,707.46
Rate for Payer: Allwell Medicaid	$13,707.46
Rate for Payer: AZCH Complete Medicaid	$13,707.46
Rate for Payer: Banner UC Health Medicaid	$13,707.46
Rate for Payer: Mercy Care Medicaid	$13,707.46

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6914
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: AHCCCS Medicaid	$28,128.24
Rate for Payer: Allwell Medicaid	$28,128.24
Rate for Payer: AZCH Complete Medicaid	$28,128.24
Rate for Payer: Banner UC Health Medicaid	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24

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