Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$8,136.94

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG2224
Min. Negotiated Rate	$8,136.94
Max. Negotiated Rate	$8,136.94
Rate for Payer: AHCCCS Medicaid	$8,136.94
Rate for Payer: Allwell Medicaid	$8,136.94
Rate for Payer: AZCH Complete Medicaid	$8,136.94
Rate for Payer: Banner UC Health Medicaid	$8,136.94
Rate for Payer: Mercy Care Medicaid	$8,136.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2221
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: AHCCCS Medicaid	$27,475.94
Rate for Payer: Allwell Medicaid	$27,475.94
Rate for Payer: AZCH Complete Medicaid	$27,475.94
Rate for Payer: Banner UC Health Medicaid	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2221
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: AHCCCS Medicaid	$13,584.01
Rate for Payer: Allwell Medicaid	$13,584.01
Rate for Payer: AZCH Complete Medicaid	$13,584.01
Rate for Payer: Banner UC Health Medicaid	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$8,136.94

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG2222
Min. Negotiated Rate	$8,136.94
Max. Negotiated Rate	$8,136.94
Rate for Payer: AHCCCS Medicaid	$8,136.94
Rate for Payer: Allwell Medicaid	$8,136.94
Rate for Payer: AZCH Complete Medicaid	$8,136.94
Rate for Payer: Banner UC Health Medicaid	$8,136.94
Rate for Payer: Mercy Care Medicaid	$8,136.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: AHCCCS Medicaid	$27,475.94
Rate for Payer: Allwell Medicaid	$27,475.94
Rate for Payer: AZCH Complete Medicaid	$27,475.94
Rate for Payer: Banner UC Health Medicaid	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2222
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: AHCCCS Medicaid	$13,584.01
Rate for Payer: Allwell Medicaid	$13,584.01
Rate for Payer: AZCH Complete Medicaid	$13,584.01
Rate for Payer: Banner UC Health Medicaid	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$5,064.81

Service Code	APR-DRG 2221
Hospital Charge Code	APRDRG2222
Min. Negotiated Rate	$5,064.81
Max. Negotiated Rate	$5,064.81
Rate for Payer: AHCCCS Medicaid	$5,064.81
Rate for Payer: Allwell Medicaid	$5,064.81
Rate for Payer: AZCH Complete Medicaid	$5,064.81
Rate for Payer: Banner UC Health Medicaid	$5,064.81
Rate for Payer: Mercy Care Medicaid	$5,064.81

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2224
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: AHCCCS Medicaid	$13,584.01
Rate for Payer: Allwell Medicaid	$13,584.01
Rate for Payer: AZCH Complete Medicaid	$13,584.01
Rate for Payer: Banner UC Health Medicaid	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2224
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: AHCCCS Medicaid	$27,475.94
Rate for Payer: Allwell Medicaid	$27,475.94
Rate for Payer: AZCH Complete Medicaid	$27,475.94
Rate for Payer: Banner UC Health Medicaid	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$8,136.94

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$8,136.94
Max. Negotiated Rate	$8,136.94
Rate for Payer: AHCCCS Medicaid	$8,136.94
Rate for Payer: Allwell Medicaid	$8,136.94
Rate for Payer: AZCH Complete Medicaid	$8,136.94
Rate for Payer: Banner UC Health Medicaid	$8,136.94
Rate for Payer: Mercy Care Medicaid	$8,136.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$13,584.01

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$13,584.01
Max. Negotiated Rate	$13,584.01
Rate for Payer: AHCCCS Medicaid	$13,584.01
Rate for Payer: Allwell Medicaid	$13,584.01
Rate for Payer: AZCH Complete Medicaid	$13,584.01
Rate for Payer: Banner UC Health Medicaid	$13,584.01
Rate for Payer: Mercy Care Medicaid	$13,584.01

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$27,475.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG2222
Min. Negotiated Rate	$27,475.94
Max. Negotiated Rate	$27,475.94
Rate for Payer: AHCCCS Medicaid	$27,475.94
Rate for Payer: Allwell Medicaid	$27,475.94
Rate for Payer: AZCH Complete Medicaid	$27,475.94
Rate for Payer: Banner UC Health Medicaid	$27,475.94
Rate for Payer: Mercy Care Medicaid	$27,475.94

Other Stomach, Esophageal And Duodenal Procedures

Facility

IP

$5,064.81

Service Code	APR-DRG 2221
Hospital Charge Code	APRDRG2223
Min. Negotiated Rate	$5,064.81
Max. Negotiated Rate	$5,064.81
Rate for Payer: AHCCCS Medicaid	$5,064.81
Rate for Payer: Allwell Medicaid	$5,064.81
Rate for Payer: AZCH Complete Medicaid	$5,064.81
Rate for Payer: Banner UC Health Medicaid	$5,064.81
Rate for Payer: Mercy Care Medicaid	$5,064.81

OT IONTOPHORESIS @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97033 GO
Hospital Charge Code	691323
Hospital Revenue Code	430
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

OT IONTOPHORESIS @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97033 GO
Hospital Charge Code	691323
Hospital Revenue Code	430
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

OT MAN THER TECH @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97140 GO
Hospital Charge Code	691319
Hospital Revenue Code	430
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

OT MAN THER TECH @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97140 GO
Hospital Charge Code	691319
Hospital Revenue Code	430
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

OT MASSAGE EA 15 MIN

Facility

OP

$181.00

Service Code	CPT 97124 GO
Hospital Charge Code	691318
Hospital Revenue Code	430
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

OT MASSAGE EA 15 MIN

Facility

IP

$181.00

Service Code	CPT 97124 GO
Hospital Charge Code	691318
Hospital Revenue Code	430
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

OT NEURO RE-ED @ 15 MIN

Facility

OP

$181.00

Service Code	CPT 97112 GO
Hospital Charge Code	691316
Hospital Revenue Code	430
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

OT NEURO RE-ED @ 15 MIN

Facility

IP

$181.00

Service Code	CPT 97112 GO
Hospital Charge Code	691316
Hospital Revenue Code	430
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

OT ORTHO FITTING/TRAINING @ 15 E

Facility

IP

$172.00

Service Code	CPT 97760 GO
Hospital Charge Code	1341990
Hospital Revenue Code	430
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

OT ORTHO FITTING/TRAINING @ 15 E

Facility

OP

$172.00

Service Code	CPT 97760 GO
Hospital Charge Code	1341990
Hospital Revenue Code	430
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: Allwell Medicare	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicare	$25.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$120.40
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$25.80
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

OT PARAFFIN BATH

Facility

OP

$181.00

Service Code	CPT 97018 GO
Hospital Charge Code	1230341
Hospital Revenue Code	430
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

OT PARAFFIN BATH

Facility

IP

$181.00

Service Code	CPT 97018 GO
Hospital Charge Code	1230341
Hospital Revenue Code	430
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

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