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

$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

$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

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$4,259.60

Service Code	APR-DRG 4212
Hospital Charge Code	APRDRG4213
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	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

$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

$3,281.15

Service Code	APR-DRG 4211
Hospital Charge Code	APRDRG4213
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

$6,868.81

Service Code	APR-DRG 4213
Hospital Charge Code	APRDRG4212
Min. Negotiated Rate	$6,868.81
Max. Negotiated Rate	$6,868.81
Rate for Payer: AHCCCS Medicaid	$6,868.81
Rate for Payer: Allwell Medicaid	$6,868.81
Rate for Payer: AZCH Complete Medicaid	$6,868.81
Rate for Payer: Banner UC Health Medicaid	$6,868.81
Rate for Payer: Mercy Care Medicaid	$6,868.81

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

$3,281.15

Service Code	APR-DRG 4211
Hospital Charge Code	APRDRG4211
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

$15,381.00

Service Code	APR-DRG 4214
Hospital Charge Code	APRDRG4214
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

$6,868.81

Service Code	APR-DRG 4213
Hospital Charge Code	APRDRG4213
Min. Negotiated Rate	$6,868.81
Max. Negotiated Rate	$6,868.81
Rate for Payer: AHCCCS Medicaid	$6,868.81
Rate for Payer: Allwell Medicaid	$6,868.81
Rate for Payer: AZCH Complete Medicaid	$6,868.81
Rate for Payer: Banner UC Health Medicaid	$6,868.81
Rate for Payer: Mercy Care Medicaid	$6,868.81

Malnutrition, Failure To Thrive And Other Nutritional Disorders

Facility

IP

$6,868.81

Service Code	APR-DRG 4213
Hospital Charge Code	APRDRG4214
Min. Negotiated Rate	$6,868.81
Max. Negotiated Rate	$6,868.81
Rate for Payer: AHCCCS Medicaid	$6,868.81
Rate for Payer: Allwell Medicaid	$6,868.81
Rate for Payer: AZCH Complete Medicaid	$6,868.81
Rate for Payer: Banner UC Health Medicaid	$6,868.81
Rate for Payer: Mercy Care Medicaid	$6,868.81

MA Mammogram Diagnostic Bilateral.

Facility

OP

$1,069.00

Service Code	CPT 77066
Hospital Charge Code	1181457
Hospital Revenue Code	401
Min. Negotiated Rate	$171.04
Max. Negotiated Rate	$962.10
Rate for Payer: Aetna of AZ Commercial	$962.10
Rate for Payer: Aetna of AZ Medicare	$299.32
Rate for Payer: Allwell Medicare	$171.04
Rate for Payer: Amerigroup Medicare	$171.04
Rate for Payer: APIPA Medicare/Medicaid	$399.27
Rate for Payer: AZCH Complete Medicare	$171.04
Rate for Payer: Banner UC Health Medicare	$171.04
Rate for Payer: Bisbee Police All Plans	$277.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$726.92
Rate for Payer: Cash Price	$855.20
Rate for Payer: Cigna of AZ Commercial	$748.30
Rate for Payer: Copperpoint Commercial	$264.58
Rate for Payer: Health Net of AZ Commercial	$641.40
Rate for Payer: Health Net of AZ Medicare	$299.32
Rate for Payer: Humana of AZ Medicare	$171.04
Rate for Payer: Self Pay Self Pay	$855.20
Rate for Payer: TriWest Medicare	$171.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$623.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$192.42

MA Mammogram Diagnostic Bilateral.

Facility

IP

$1,069.00

Service Code	CPT 77066
Hospital Charge Code	1181457
Hospital Revenue Code	401
Min. Negotiated Rate	$277.94
Max. Negotiated Rate	$962.10
Rate for Payer: Aetna of AZ Commercial	$962.10
Rate for Payer: Bisbee Police All Plans	$277.94
Rate for Payer: Cash Price	$855.20
Rate for Payer: Self Pay Self Pay	$855.20

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	$144.96
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	$144.96
Rate for Payer: Amerigroup Medicare	$144.96
Rate for Payer: APIPA Medicare/Medicaid	$338.39
Rate for Payer: AZCH Complete Medicare	$144.96
Rate for Payer: Banner UC Health Medicare	$144.96
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	$144.96
Rate for Payer: Self Pay Self Pay	$724.80
Rate for Payer: TriWest Medicare	$144.96
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

$861.00

Service Code	CPT 77065 RT
Hospital Charge Code	1189738
Hospital Revenue Code	401
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Cash Price	$688.80
Rate for Payer: Self Pay Self Pay	$688.80

MA Mammogram Diagnostic Right.

Facility

OP

$861.00

Service Code	CPT 77065 RT
Hospital Charge Code	1189738
Hospital Revenue Code	401
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$774.90
Rate for Payer: Aetna of AZ Commercial	$774.90
Rate for Payer: Aetna of AZ Medicare	$241.08
Rate for Payer: Allwell Medicare	$137.76
Rate for Payer: Amerigroup Medicare	$137.76
Rate for Payer: APIPA Medicare/Medicaid	$321.58
Rate for Payer: AZCH Complete Medicare	$137.76
Rate for Payer: Banner UC Health Medicare	$137.76
Rate for Payer: Bisbee Police All Plans	$223.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$585.48
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cigna of AZ Commercial	$602.70
Rate for Payer: Copperpoint Commercial	$213.10
Rate for Payer: Health Net of AZ Commercial	$516.60
Rate for Payer: Health Net of AZ Medicare	$241.08
Rate for Payer: Humana of AZ Medicare	$137.76
Rate for Payer: Self Pay Self Pay	$688.80
Rate for Payer: TriWest Medicare	$137.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$501.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$154.98

MA Mammogram Routine Screening Bilat.

Facility

IP

$828.00

Service Code	CPT 77067
Hospital Charge Code	1181460
Hospital Revenue Code	403
Min. Negotiated Rate	$215.28
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Cash Price	$662.40
Rate for Payer: Self Pay Self Pay	$662.40

MA Mammogram Routine Screening Bilat.

Facility

OP

$828.00

Service Code	CPT 77067
Hospital Charge Code	1181460
Hospital Revenue Code	403
Min. Negotiated Rate	$132.48
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Aetna of AZ Medicare	$231.84
Rate for Payer: Allwell Medicare	$132.48
Rate for Payer: Amerigroup Medicare	$132.48
Rate for Payer: APIPA Medicare/Medicaid	$309.26
Rate for Payer: AZCH Complete Medicare	$132.48
Rate for Payer: Banner UC Health Medicare	$132.48
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$563.04
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cigna of AZ Commercial	$579.60
Rate for Payer: Copperpoint Commercial	$204.93
Rate for Payer: Health Net of AZ Commercial	$496.80
Rate for Payer: Health Net of AZ Medicare	$231.84
Rate for Payer: Humana of AZ Medicare	$132.48
Rate for Payer: Self Pay Self Pay	$662.40
Rate for Payer: TriWest Medicare	$132.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$482.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.04

MANIPULATION OF STONE IN URETER USING AN ENDOSCOPE Tech

Facility

IP

$1,363.00

Service Code	CPT 52330
Hospital Charge Code	27883522
Hospital Revenue Code	360
Min. Negotiated Rate	$354.38
Max. Negotiated Rate	$1,226.70
Rate for Payer: Aetna of AZ Commercial	$1,226.70
Rate for Payer: Bisbee Police All Plans	$354.38
Rate for Payer: Cash Price	$1,090.40
Rate for Payer: Self Pay Self Pay	$1,090.40

MANIPULATION OF STONE IN URETER USING AN ENDOSCOPE Tech

Facility

OP

$1,363.00

Service Code	CPT 52330
Hospital Charge Code	27883522
Hospital Revenue Code	360
Min. Negotiated Rate	$218.08
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,226.70
Rate for Payer: Aetna of AZ Medicare	$381.64
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$218.08
Rate for Payer: Amerigroup Medicare	$218.08
Rate for Payer: APIPA Medicare/Medicaid	$509.08
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$218.08
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$218.08
Rate for Payer: Bisbee Police All Plans	$354.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$926.84
Rate for Payer: Cash Price	$1,090.40
Rate for Payer: Cash Price	$1,090.40
Rate for Payer: Cigna of AZ Commercial	$681.50
Rate for Payer: Copperpoint Commercial	$337.34
Rate for Payer: Health Net of AZ Commercial	$817.80
Rate for Payer: Health Net of AZ Medicare	$381.64
Rate for Payer: Humana of AZ Medicare	$218.08
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$1,090.40
Rate for Payer: TriWest Medicare	$218.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$245.34

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

Facility

OP

$47.00

Service Code	CPT 85007
Hospital Charge Code	22394401
Hospital Revenue Code	305
Min. Negotiated Rate	$7.52
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: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
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: 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	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Manual Differential Standard

Facility

OP

$45.00

Service Code	CPT 85007
Hospital Charge Code	22242914
Hospital Revenue Code	305
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$29.25
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

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