Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$6,929.83

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG9514
Min. Negotiated Rate	$6,929.83
Max. Negotiated Rate	$6,929.83
Rate for Payer: AHCCCS Medicaid	$6,929.83
Rate for Payer: Allwell Medicaid	$6,929.83
Rate for Payer: AZCH Complete Medicaid	$6,929.83
Rate for Payer: Banner UC Health Medicaid	$6,929.83
Rate for Payer: Mercy Care Medicaid	$6,929.83

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: AHCCCS Medicaid	$15,718.37
Rate for Payer: Allwell Medicaid	$15,718.37
Rate for Payer: AZCH Complete Medicaid	$15,718.37
Rate for Payer: Banner UC Health Medicaid	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$29,766.71

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$29,766.71
Max. Negotiated Rate	$29,766.71
Rate for Payer: AHCCCS Medicaid	$29,766.71
Rate for Payer: Allwell Medicaid	$29,766.71
Rate for Payer: AZCH Complete Medicaid	$29,766.71
Rate for Payer: Banner UC Health Medicaid	$29,766.71
Rate for Payer: Mercy Care Medicaid	$29,766.71

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$29,766.71

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG9512
Min. Negotiated Rate	$29,766.71
Max. Negotiated Rate	$29,766.71
Rate for Payer: AHCCCS Medicaid	$29,766.71
Rate for Payer: Allwell Medicaid	$29,766.71
Rate for Payer: AZCH Complete Medicaid	$29,766.71
Rate for Payer: Banner UC Health Medicaid	$29,766.71
Rate for Payer: Mercy Care Medicaid	$29,766.71

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9512
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: AHCCCS Medicaid	$15,718.37
Rate for Payer: Allwell Medicaid	$15,718.37
Rate for Payer: AZCH Complete Medicaid	$15,718.37
Rate for Payer: Banner UC Health Medicaid	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9514
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: AHCCCS Medicaid	$10,065.79
Rate for Payer: Allwell Medicaid	$10,065.79
Rate for Payer: AZCH Complete Medicaid	$10,065.79
Rate for Payer: Banner UC Health Medicaid	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$29,766.71

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG9514
Min. Negotiated Rate	$29,766.71
Max. Negotiated Rate	$29,766.71
Rate for Payer: AHCCCS Medicaid	$29,766.71
Rate for Payer: Allwell Medicaid	$29,766.71
Rate for Payer: AZCH Complete Medicaid	$29,766.71
Rate for Payer: Banner UC Health Medicaid	$29,766.71
Rate for Payer: Mercy Care Medicaid	$29,766.71

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: AHCCCS Medicaid	$10,065.79
Rate for Payer: Allwell Medicaid	$10,065.79
Rate for Payer: AZCH Complete Medicaid	$10,065.79
Rate for Payer: Banner UC Health Medicaid	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: AHCCCS Medicaid	$10,065.79
Rate for Payer: Allwell Medicaid	$10,065.79
Rate for Payer: AZCH Complete Medicaid	$10,065.79
Rate for Payer: Banner UC Health Medicaid	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$6,929.83

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$6,929.83
Max. Negotiated Rate	$6,929.83
Rate for Payer: AHCCCS Medicaid	$6,929.83
Rate for Payer: Allwell Medicaid	$6,929.83
Rate for Payer: AZCH Complete Medicaid	$6,929.83
Rate for Payer: Banner UC Health Medicaid	$6,929.83
Rate for Payer: Mercy Care Medicaid	$6,929.83

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9511
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: AHCCCS Medicaid	$15,718.37
Rate for Payer: Allwell Medicaid	$15,718.37
Rate for Payer: AZCH Complete Medicaid	$15,718.37
Rate for Payer: Banner UC Health Medicaid	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$6,929.83

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$6,929.83
Max. Negotiated Rate	$6,929.83
Rate for Payer: AHCCCS Medicaid	$6,929.83
Rate for Payer: Allwell Medicaid	$6,929.83
Rate for Payer: AZCH Complete Medicaid	$6,929.83
Rate for Payer: Banner UC Health Medicaid	$6,929.83
Rate for Payer: Mercy Care Medicaid	$6,929.83

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$15,718.37

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG9514
Min. Negotiated Rate	$15,718.37
Max. Negotiated Rate	$15,718.37
Rate for Payer: AHCCCS Medicaid	$15,718.37
Rate for Payer: Allwell Medicaid	$15,718.37
Rate for Payer: AZCH Complete Medicaid	$15,718.37
Rate for Payer: Banner UC Health Medicaid	$15,718.37
Rate for Payer: Mercy Care Medicaid	$15,718.37

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$10,065.79

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG9512
Min. Negotiated Rate	$10,065.79
Max. Negotiated Rate	$10,065.79
Rate for Payer: AHCCCS Medicaid	$10,065.79
Rate for Payer: Allwell Medicaid	$10,065.79
Rate for Payer: AZCH Complete Medicaid	$10,065.79
Rate for Payer: Banner UC Health Medicaid	$10,065.79
Rate for Payer: Mercy Care Medicaid	$10,065.79

Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis

Facility

IP

$29,766.71

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG9513
Min. Negotiated Rate	$29,766.71
Max. Negotiated Rate	$29,766.71
Rate for Payer: AHCCCS Medicaid	$29,766.71
Rate for Payer: Allwell Medicaid	$29,766.71
Rate for Payer: AZCH Complete Medicaid	$29,766.71
Rate for Payer: Banner UC Health Medicaid	$29,766.71
Rate for Payer: Mercy Care Medicaid	$29,766.71

.MOLECULAR CYTOGEN DNA PROBE FISH

Facility

IP

$195.00

Service Code	CPT 88271
Hospital Charge Code	22481448
Hospital Revenue Code	310
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Cash Price	$156.00
Rate for Payer: Self Pay Self Pay	$156.00

.MOLECULAR CYTOGEN DNA PROBE FISH

Facility

OP

$195.00

Service Code	CPT 88271
Hospital Charge Code	22481448
Hospital Revenue Code	310
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna of AZ Commercial	$175.50
Rate for Payer: Aetna of AZ Medicare	$54.60
Rate for Payer: AHCCCS Medicaid	$21.42
Rate for Payer: Allwell Medicaid	$21.42
Rate for Payer: Allwell Medicare	$29.25
Rate for Payer: Amerigroup Medicare	$29.25
Rate for Payer: APIPA Medicare/Medicaid	$72.83
Rate for Payer: AZCH Complete Medicaid	$21.42
Rate for Payer: AZCH Complete Medicare	$29.25
Rate for Payer: Banner UC Health Medicaid	$21.42
Rate for Payer: Banner UC Health Medicare	$29.25
Rate for Payer: Bisbee Police All Plans	$50.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$132.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cigna of AZ Commercial	$126.75
Rate for Payer: Copperpoint Commercial	$48.26
Rate for Payer: Health Net of AZ Commercial	$117.00
Rate for Payer: Health Net of AZ Medicare	$54.60
Rate for Payer: Humana of AZ Medicare	$29.25
Rate for Payer: Mercy Care Medicaid	$21.42
Rate for Payer: Self Pay Self Pay	$156.00
Rate for Payer: TriWest Medicare	$29.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$113.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.10

Mononucleosis Screen

Facility

IP

$136.00

Service Code	CPT 86308
Hospital Charge Code	633785
Hospital Revenue Code	302
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of AZ Commercial	$122.40
Rate for Payer: Bisbee Police All Plans	$35.36
Rate for Payer: Cash Price	$108.80
Rate for Payer: Self Pay Self Pay	$108.80

Mononucleosis Screen

Facility

OP

$136.00

Service Code	CPT 86308
Hospital Charge Code	633785
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of AZ Commercial	$122.40
Rate for Payer: Aetna of AZ Medicare	$38.08
Rate for Payer: AHCCCS Medicaid	$5.18
Rate for Payer: Allwell Medicaid	$5.18
Rate for Payer: Allwell Medicare	$20.40
Rate for Payer: Amerigroup Medicare	$20.40
Rate for Payer: APIPA Medicare/Medicaid	$50.80
Rate for Payer: AZCH Complete Medicaid	$5.18
Rate for Payer: AZCH Complete Medicare	$20.40
Rate for Payer: Banner UC Health Medicaid	$5.18
Rate for Payer: Banner UC Health Medicare	$20.40
Rate for Payer: Bisbee Police All Plans	$35.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$92.48
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cigna of AZ Commercial	$88.40
Rate for Payer: Copperpoint Commercial	$33.66
Rate for Payer: Health Net of AZ Commercial	$81.60
Rate for Payer: Health Net of AZ Medicare	$38.08
Rate for Payer: Humana of AZ Medicare	$20.40
Rate for Payer: Mercy Care Medicaid	$5.18
Rate for Payer: Self Pay Self Pay	$108.80
Rate for Payer: TriWest Medicare	$20.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$79.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.48

Monsel's (ferric subsulfate) topical Soln [CQCH]

Facility

IP

$1.84

Service Code	NDC 48783011208
Hospital Charge Code	114598869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Cash Price	$1.47
Rate for Payer: Self Pay Self Pay	$1.47

Monsel's (ferric subsulfate) topical Soln [CQCH]

Facility

OP

$1.84

Service Code	NDC 48783011208
Hospital Charge Code	114598869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Aetna of AZ Medicare	$0.52
Rate for Payer: Allwell Medicare	$0.28
Rate for Payer: Amerigroup Medicare	$0.28
Rate for Payer: APIPA Medicare/Medicaid	$0.69
Rate for Payer: AZCH Complete Medicare	$0.28
Rate for Payer: Banner UC Health Medicare	$0.28
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.25
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.20
Rate for Payer: Copperpoint Commercial	$0.46
Rate for Payer: Health Net of AZ Commercial	$1.10
Rate for Payer: Health Net of AZ Medicare	$0.52
Rate for Payer: Humana of AZ Medicare	$0.28
Rate for Payer: Self Pay Self Pay	$1.47
Rate for Payer: TriWest Medicare	$0.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.33

montelukast 10 mg Tab [CQCH]

Facility

IP

$2.49

Service Code	NDC 50268057515
Hospital Charge Code	105932568
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.24
Rate for Payer: Aetna of AZ Commercial	$2.24
Rate for Payer: Bisbee Police All Plans	$0.65
Rate for Payer: Cash Price	$1.99
Rate for Payer: Self Pay Self Pay	$1.99

montelukast 10 mg Tab [CQCH]

Facility

OP

$2.49

Service Code	NDC 50268057515
Hospital Charge Code	105932568
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$2.24
Rate for Payer: Aetna of AZ Commercial	$2.24
Rate for Payer: Aetna of AZ Medicare	$0.70
Rate for Payer: Allwell Medicare	$0.37
Rate for Payer: Amerigroup Medicare	$0.37
Rate for Payer: APIPA Medicare/Medicaid	$0.93
Rate for Payer: AZCH Complete Medicare	$0.37
Rate for Payer: Banner UC Health Medicare	$0.37
Rate for Payer: Bisbee Police All Plans	$0.65
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.69
Rate for Payer: Cash Price	$1.99
Rate for Payer: Cigna of AZ Commercial	$1.62
Rate for Payer: Copperpoint Commercial	$0.62
Rate for Payer: Health Net of AZ Commercial	$1.49
Rate for Payer: Health Net of AZ Medicare	$0.70
Rate for Payer: Humana of AZ Medicare	$0.37
Rate for Payer: Self Pay Self Pay	$1.99
Rate for Payer: TriWest Medicare	$0.37
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.45

MORGAN LENSE

Facility

OP

$118.00

Hospital Charge Code	22354271
Hospital Revenue Code	270
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Aetna of AZ Medicare	$33.04
Rate for Payer: Allwell Medicare	$17.70
Rate for Payer: Amerigroup Medicare	$17.70
Rate for Payer: APIPA Medicare/Medicaid	$44.07
Rate for Payer: AZCH Complete Medicare	$17.70
Rate for Payer: Banner UC Health Medicare	$17.70
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$80.24
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cigna of AZ Commercial	$82.60
Rate for Payer: Copperpoint Commercial	$29.20
Rate for Payer: Health Net of AZ Commercial	$70.80
Rate for Payer: Health Net of AZ Medicare	$33.04
Rate for Payer: Humana of AZ Medicare	$17.70
Rate for Payer: Self Pay Self Pay	$94.40
Rate for Payer: TriWest Medicare	$17.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$68.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.24

MORGAN LENSE

Facility

IP

$118.00

Hospital Charge Code	22354271
Hospital Revenue Code	270
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna of AZ Commercial	$106.20
Rate for Payer: Bisbee Police All Plans	$30.68
Rate for Payer: Cash Price	$94.40
Rate for Payer: Self Pay Self Pay	$94.40

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