Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$15,381.00

Service Code	APR-DRG 4214
Hospital Charge Code	APRDRG4212
Min. Negotiated Rate	$15,381.00
Max. Negotiated Rate	$15,381.00
Rate for Payer: AHCCCS Medicaid	$15,381.00
Rate for Payer: Allwell Medicaid	$15,381.00
Rate for Payer: AZCH Complete Medicaid	$15,381.00
Rate for Payer: Banner UC Health Medicaid	$15,381.00
Rate for Payer: Mercy Care Medicaid	$15,381.00

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$15,381.00

Service Code	APR-DRG 4214
Hospital Charge Code	APRDRG4213
Min. Negotiated Rate	$15,381.00
Max. Negotiated Rate	$15,381.00
Rate for Payer: AHCCCS Medicaid	$15,381.00
Rate for Payer: Allwell Medicaid	$15,381.00
Rate for Payer: AZCH Complete Medicaid	$15,381.00
Rate for Payer: Banner UC Health Medicaid	$15,381.00
Rate for Payer: Mercy Care Medicaid	$15,381.00

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$4,259.60

Service Code	APR-DRG 4212
Hospital Charge Code	APRDRG4214
Min. Negotiated Rate	$4,259.60
Max. Negotiated Rate	$4,259.60
Rate for Payer: AHCCCS Medicaid	$4,259.60
Rate for Payer: Allwell Medicaid	$4,259.60
Rate for Payer: AZCH Complete Medicaid	$4,259.60
Rate for Payer: Banner UC Health Medicaid	$4,259.60
Rate for Payer: Mercy Care Medicaid	$4,259.60

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$3,281.15

Service Code	APR-DRG 4211
Hospital Charge Code	APRDRG4212
Min. Negotiated Rate	$3,281.15
Max. Negotiated Rate	$3,281.15
Rate for Payer: AHCCCS Medicaid	$3,281.15
Rate for Payer: Allwell Medicaid	$3,281.15
Rate for Payer: AZCH Complete Medicaid	$3,281.15
Rate for Payer: Banner UC Health Medicaid	$3,281.15
Rate for Payer: Mercy Care Medicaid	$3,281.15

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$3,281.15

Service Code	APR-DRG 4211
Hospital Charge Code	APRDRG4214
Min. Negotiated Rate	$3,281.15
Max. Negotiated Rate	$3,281.15
Rate for Payer: AHCCCS Medicaid	$3,281.15
Rate for Payer: Allwell Medicaid	$3,281.15
Rate for Payer: AZCH Complete Medicaid	$3,281.15
Rate for Payer: Banner UC Health Medicaid	$3,281.15
Rate for Payer: Mercy Care Medicaid	$3,281.15

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$4,259.60

Service Code	APR-DRG 4212
Hospital Charge Code	APRDRG4212
Min. Negotiated Rate	$4,259.60
Max. Negotiated Rate	$4,259.60
Rate for Payer: AHCCCS Medicaid	$4,259.60
Rate for Payer: Allwell Medicaid	$4,259.60
Rate for Payer: AZCH Complete Medicaid	$4,259.60
Rate for Payer: Banner UC Health Medicaid	$4,259.60
Rate for Payer: Mercy Care Medicaid	$4,259.60

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$4,259.60

Service Code	APR-DRG 4212
Hospital Charge Code	APRDRG4211
Min. Negotiated Rate	$4,259.60
Max. Negotiated Rate	$4,259.60
Rate for Payer: AHCCCS Medicaid	$4,259.60
Rate for Payer: Allwell Medicaid	$4,259.60
Rate for Payer: AZCH Complete Medicaid	$4,259.60
Rate for Payer: Banner UC Health Medicaid	$4,259.60
Rate for Payer: Mercy Care Medicaid	$4,259.60

MA Mammogram Diagnostic Bilateral.

Facility

OP

$1,125.00

Service Code	CPT 77066
Hospital Charge Code	1181457
Hospital Revenue Code	401
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna of AZ Commercial	$1,012.50
Rate for Payer: Aetna of AZ Medicare	$315.00
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$168.75
Rate for Payer: Amerigroup Medicare	$168.75
Rate for Payer: APIPA Medicare/Medicaid	$420.19
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$168.75
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$168.75
Rate for Payer: Bisbee Police All Plans	$292.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$765.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna of AZ Commercial	$787.50
Rate for Payer: Copperpoint Commercial	$278.44
Rate for Payer: Health Net of AZ Commercial	$675.00
Rate for Payer: Health Net of AZ Medicare	$315.00
Rate for Payer: Humana of AZ Medicare	$168.75
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$900.00
Rate for Payer: TriWest Medicare	$168.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$655.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$202.50

MA Mammogram Diagnostic Bilateral.

Facility

IP

$1,125.00

Service Code	CPT 77066
Hospital Charge Code	1181457
Hospital Revenue Code	401
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna of AZ Commercial	$1,012.50
Rate for Payer: Bisbee Police All Plans	$292.50
Rate for Payer: Cash Price	$900.00
Rate for Payer: Self Pay Self Pay	$900.00

MA Mammogram Diagnostic Left.

Facility

IP

$906.00

Service Code	CPT 77065 LT
Hospital Charge Code	1240707
Hospital Revenue Code	401
Min. Negotiated Rate	$235.56
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna of AZ Commercial	$815.40
Rate for Payer: Bisbee Police All Plans	$235.56
Rate for Payer: Cash Price	$724.80
Rate for Payer: Self Pay Self Pay	$724.80

MA Mammogram Diagnostic Left.

Facility

OP

$906.00

Service Code	CPT 77065 LT
Hospital Charge Code	1240707
Hospital Revenue Code	401
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna of AZ Commercial	$815.40
Rate for Payer: Aetna of AZ Medicare	$253.68
Rate for Payer: Allwell Medicare	$135.90
Rate for Payer: Amerigroup Medicare	$135.90
Rate for Payer: APIPA Medicare/Medicaid	$338.39
Rate for Payer: AZCH Complete Medicare	$135.90
Rate for Payer: Banner UC Health Medicare	$135.90
Rate for Payer: Bisbee Police All Plans	$235.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$616.08
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cigna of AZ Commercial	$634.20
Rate for Payer: Copperpoint Commercial	$224.24
Rate for Payer: Health Net of AZ Commercial	$543.60
Rate for Payer: Health Net of AZ Medicare	$253.68
Rate for Payer: Humana of AZ Medicare	$135.90
Rate for Payer: Self Pay Self Pay	$724.80
Rate for Payer: TriWest Medicare	$135.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$528.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$163.08

MA Mammogram Diagnostic Right.

Facility

IP

$906.00

Service Code	CPT 77065 RT
Hospital Charge Code	1189738
Hospital Revenue Code	401
Min. Negotiated Rate	$235.56
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna of AZ Commercial	$815.40
Rate for Payer: Bisbee Police All Plans	$235.56
Rate for Payer: Cash Price	$724.80
Rate for Payer: Self Pay Self Pay	$724.80

MA Mammogram Diagnostic Right.

Facility

OP

$906.00

Service Code	CPT 77065 RT
Hospital Charge Code	1189738
Hospital Revenue Code	401
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$815.40
Rate for Payer: Aetna of AZ Commercial	$815.40
Rate for Payer: Aetna of AZ Medicare	$253.68
Rate for Payer: Allwell Medicare	$135.90
Rate for Payer: Amerigroup Medicare	$135.90
Rate for Payer: APIPA Medicare/Medicaid	$338.39
Rate for Payer: AZCH Complete Medicare	$135.90
Rate for Payer: Banner UC Health Medicare	$135.90
Rate for Payer: Bisbee Police All Plans	$235.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$616.08
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cigna of AZ Commercial	$634.20
Rate for Payer: Copperpoint Commercial	$224.24
Rate for Payer: Health Net of AZ Commercial	$543.60
Rate for Payer: Health Net of AZ Medicare	$253.68
Rate for Payer: Humana of AZ Medicare	$135.90
Rate for Payer: Self Pay Self Pay	$724.80
Rate for Payer: TriWest Medicare	$135.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$528.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$163.08

MA Mammogram Routine Screening Bilat.

Facility

OP

$872.00

Service Code	CPT 77067
Hospital Charge Code	1181460
Hospital Revenue Code	403
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$784.80
Rate for Payer: Aetna of AZ Commercial	$784.80
Rate for Payer: Aetna of AZ Medicare	$244.16
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$130.80
Rate for Payer: Amerigroup Medicare	$130.80
Rate for Payer: APIPA Medicare/Medicaid	$325.69
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$130.80
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$130.80
Rate for Payer: Bisbee Police All Plans	$226.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$592.96
Rate for Payer: Cash Price	$697.60
Rate for Payer: Cash Price	$697.60
Rate for Payer: Cigna of AZ Commercial	$610.40
Rate for Payer: Copperpoint Commercial	$215.82
Rate for Payer: Health Net of AZ Commercial	$523.20
Rate for Payer: Health Net of AZ Medicare	$244.16
Rate for Payer: Humana of AZ Medicare	$130.80
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$697.60
Rate for Payer: TriWest Medicare	$130.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$508.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$156.96

MA Mammogram Routine Screening Bilat.

Facility

IP

$872.00

Service Code	CPT 77067
Hospital Charge Code	1181460
Hospital Revenue Code	403
Min. Negotiated Rate	$226.72
Max. Negotiated Rate	$784.80
Rate for Payer: Aetna of AZ Commercial	$784.80
Rate for Payer: Bisbee Police All Plans	$226.72
Rate for Payer: Cash Price	$697.60
Rate for Payer: Self Pay Self Pay	$697.60

Manual Differential

Facility

OP

$47.00

Service Code	CPT 85007
Hospital Charge Code	22394401
Hospital Revenue Code	305
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: AHCCCS Medicaid	$3.80
Rate for Payer: Allwell Medicaid	$3.80
Rate for Payer: Allwell Medicare	$7.05
Rate for Payer: Amerigroup Medicare	$7.05
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicaid	$3.80
Rate for Payer: AZCH Complete Medicare	$7.05
Rate for Payer: Banner UC Health Medicaid	$3.80
Rate for Payer: Banner UC Health Medicare	$7.05
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.05
Rate for Payer: Mercy Care Medicaid	$3.80
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Manual Differential

Facility

IP

$47.00

Service Code	CPT 85007
Hospital Charge Code	22394401
Hospital Revenue Code	305
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

Manual Differential Standard

Facility

OP

$29.00

Service Code	CPT 85007
Hospital Charge Code	22242914
Hospital Revenue Code	305
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: AHCCCS Medicaid	$3.80
Rate for Payer: Allwell Medicaid	$3.80
Rate for Payer: Allwell Medicare	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicaid	$3.80
Rate for Payer: AZCH Complete Medicare	$4.35
Rate for Payer: Banner UC Health Medicaid	$3.80
Rate for Payer: Banner UC Health Medicare	$4.35
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$18.85
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.35
Rate for Payer: Mercy Care Medicaid	$3.80
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

Manual Differential Standard

Facility

IP

$29.00

Service Code	CPT 85007
Hospital Charge Code	22242914
Hospital Revenue Code	305
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

Manual Therapy Charge Units

Facility

OP

$181.00

Service Code	CPT 97140 GP
Hospital Charge Code	692252
Hospital Revenue Code	420
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$126.70
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

Manual Therapy Charge Units

Facility

IP

$181.00

Service Code	CPT 97140 GP
Hospital Charge Code	692252
Hospital Revenue Code	420
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

MASIMO INFANT SENSOR 18IN

Facility

IP

$67.00

Hospital Charge Code	24316100
Hospital Revenue Code	270
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

MASIMO INFANT SENSOR 18IN

Facility

OP

$67.00

Hospital Charge Code	24316100
Hospital Revenue Code	270
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.05
Rate for Payer: Amerigroup Medicare	$10.05
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.05
Rate for Payer: Banner UC Health Medicare	$10.05
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$46.90
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.05
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

MASK AEROSOL PED

Facility

IP

$563.00

Hospital Charge Code	22354238
Hospital Revenue Code	270
Min. Negotiated Rate	$146.38
Max. Negotiated Rate	$506.70
Rate for Payer: Aetna of AZ Commercial	$506.70
Rate for Payer: Bisbee Police All Plans	$146.38
Rate for Payer: Cash Price	$450.40
Rate for Payer: Self Pay Self Pay	$450.40

MASK AEROSOL PED

Facility

OP

$563.00

Hospital Charge Code	22354238
Hospital Revenue Code	270
Min. Negotiated Rate	$84.45
Max. Negotiated Rate	$506.70
Rate for Payer: Aetna of AZ Commercial	$506.70
Rate for Payer: Aetna of AZ Medicare	$157.64
Rate for Payer: Allwell Medicare	$84.45
Rate for Payer: Amerigroup Medicare	$84.45
Rate for Payer: APIPA Medicare/Medicaid	$210.28
Rate for Payer: AZCH Complete Medicare	$84.45
Rate for Payer: Banner UC Health Medicare	$84.45
Rate for Payer: Bisbee Police All Plans	$146.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$382.84
Rate for Payer: Cash Price	$450.40
Rate for Payer: Cigna of AZ Commercial	$394.10
Rate for Payer: Copperpoint Commercial	$139.34
Rate for Payer: Health Net of AZ Commercial	$337.80
Rate for Payer: Health Net of AZ Medicare	$157.64
Rate for Payer: Humana of AZ Medicare	$84.45
Rate for Payer: Self Pay Self Pay	$450.40
Rate for Payer: TriWest Medicare	$84.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$328.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$101.34

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