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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$26,639.87

Service Code	APR-DRG 1303
Hospital Charge Code	APRDRG1302
Min. Negotiated Rate	$26,639.87
Max. Negotiated Rate	$26,639.87
Rate for Payer: AHCCCS Medicaid	$26,639.87
Rate for Payer: Allwell Medicaid	$26,639.87
Rate for Payer: AZCH Complete Medicaid	$26,639.87
Rate for Payer: Banner UC Health Medicaid	$26,639.87
Rate for Payer: Mercy Care Medicaid	$26,639.87

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$19,074.57

Service Code	APR-DRG 1301
Hospital Charge Code	APRDRG1302
Min. Negotiated Rate	$19,074.57
Max. Negotiated Rate	$19,074.57
Rate for Payer: AHCCCS Medicaid	$19,074.57
Rate for Payer: Allwell Medicaid	$19,074.57
Rate for Payer: AZCH Complete Medicaid	$19,074.57
Rate for Payer: Banner UC Health Medicaid	$19,074.57
Rate for Payer: Mercy Care Medicaid	$19,074.57

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$35,760.18

Service Code	APR-DRG 1304
Hospital Charge Code	APRDRG1301
Min. Negotiated Rate	$35,760.18
Max. Negotiated Rate	$35,760.18
Rate for Payer: AHCCCS Medicaid	$35,760.18
Rate for Payer: Allwell Medicaid	$35,760.18
Rate for Payer: AZCH Complete Medicaid	$35,760.18
Rate for Payer: Banner UC Health Medicaid	$35,760.18
Rate for Payer: Mercy Care Medicaid	$35,760.18

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$26,639.87

Service Code	APR-DRG 1303
Hospital Charge Code	APRDRG1303
Min. Negotiated Rate	$26,639.87
Max. Negotiated Rate	$26,639.87
Rate for Payer: AHCCCS Medicaid	$26,639.87
Rate for Payer: Allwell Medicaid	$26,639.87
Rate for Payer: AZCH Complete Medicaid	$26,639.87
Rate for Payer: Banner UC Health Medicaid	$26,639.87
Rate for Payer: Mercy Care Medicaid	$26,639.87

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$19,074.57

Service Code	APR-DRG 1301
Hospital Charge Code	APRDRG1301
Min. Negotiated Rate	$19,074.57
Max. Negotiated Rate	$19,074.57
Rate for Payer: AHCCCS Medicaid	$19,074.57
Rate for Payer: Allwell Medicaid	$19,074.57
Rate for Payer: AZCH Complete Medicaid	$19,074.57
Rate for Payer: Banner UC Health Medicaid	$19,074.57
Rate for Payer: Mercy Care Medicaid	$19,074.57

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$22,654.52

Service Code	APR-DRG 1302
Hospital Charge Code	APRDRG1301
Min. Negotiated Rate	$22,654.52
Max. Negotiated Rate	$22,654.52
Rate for Payer: AHCCCS Medicaid	$22,654.52
Rate for Payer: Allwell Medicaid	$22,654.52
Rate for Payer: AZCH Complete Medicaid	$22,654.52
Rate for Payer: Banner UC Health Medicaid	$22,654.52
Rate for Payer: Mercy Care Medicaid	$22,654.52

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$26,639.87

Service Code	APR-DRG 1303
Hospital Charge Code	APRDRG1304
Min. Negotiated Rate	$26,639.87
Max. Negotiated Rate	$26,639.87
Rate for Payer: AHCCCS Medicaid	$26,639.87
Rate for Payer: Allwell Medicaid	$26,639.87
Rate for Payer: AZCH Complete Medicaid	$26,639.87
Rate for Payer: Banner UC Health Medicaid	$26,639.87
Rate for Payer: Mercy Care Medicaid	$26,639.87

Respiratory System Diagnosis With Ventilator Support > 96 Hours

Facility

IP

$22,654.52

Service Code	APR-DRG 1302
Hospital Charge Code	APRDRG1302
Min. Negotiated Rate	$22,654.52
Max. Negotiated Rate	$22,654.52
Rate for Payer: AHCCCS Medicaid	$22,654.52
Rate for Payer: Allwell Medicaid	$22,654.52
Rate for Payer: AZCH Complete Medicaid	$22,654.52
Rate for Payer: Banner UC Health Medicaid	$22,654.52
Rate for Payer: Mercy Care Medicaid	$22,654.52

Respiratory Therapy

Facility

OP

$853.00

Service Code	CPT 94060
Hospital Charge Code	884915
Hospital Revenue Code	460
Min. Negotiated Rate	$136.48
Max. Negotiated Rate	$767.70
Rate for Payer: Aetna of AZ Commercial	$767.70
Rate for Payer: Aetna of AZ Medicare	$238.84
Rate for Payer: AHCCCS Medicaid	$191.73
Rate for Payer: Allwell Medicaid	$191.73
Rate for Payer: Allwell Medicare	$136.48
Rate for Payer: Amerigroup Medicare	$136.48
Rate for Payer: APIPA Medicare/Medicaid	$318.60
Rate for Payer: AZCH Complete Medicaid	$191.73
Rate for Payer: AZCH Complete Medicare	$136.48
Rate for Payer: Banner UC Health Medicaid	$191.73
Rate for Payer: Banner UC Health Medicare	$136.48
Rate for Payer: Bisbee Police All Plans	$221.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$580.04
Rate for Payer: Cash Price	$682.40
Rate for Payer: Cash Price	$682.40
Rate for Payer: Cigna of AZ Commercial	$597.10
Rate for Payer: Copperpoint Commercial	$211.12
Rate for Payer: Health Net of AZ Commercial	$511.80
Rate for Payer: Health Net of AZ Medicare	$238.84
Rate for Payer: Humana of AZ Medicare	$136.48
Rate for Payer: Mercy Care Medicaid	$191.73
Rate for Payer: Self Pay Self Pay	$682.40
Rate for Payer: TriWest Medicare	$136.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$497.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$153.54

Respiratory Therapy

Facility

OP

$771.00

Service Code	CPT 94010
Hospital Charge Code	853605
Hospital Revenue Code	460
Min. Negotiated Rate	$123.36
Max. Negotiated Rate	$693.90
Rate for Payer: Aetna of AZ Commercial	$693.90
Rate for Payer: Aetna of AZ Medicare	$215.88
Rate for Payer: Allwell Medicare	$123.36
Rate for Payer: Amerigroup Medicare	$123.36
Rate for Payer: APIPA Medicare/Medicaid	$287.97
Rate for Payer: AZCH Complete Medicare	$123.36
Rate for Payer: Banner UC Health Medicare	$123.36
Rate for Payer: Bisbee Police All Plans	$200.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$524.28
Rate for Payer: Cash Price	$616.80
Rate for Payer: Cigna of AZ Commercial	$539.70
Rate for Payer: Copperpoint Commercial	$190.82
Rate for Payer: Health Net of AZ Commercial	$462.60
Rate for Payer: Health Net of AZ Medicare	$215.88
Rate for Payer: Humana of AZ Medicare	$123.36
Rate for Payer: Self Pay Self Pay	$616.80
Rate for Payer: TriWest Medicare	$123.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$449.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.78

Respiratory Therapy

Facility

IP

$771.00

Service Code	CPT 94010
Hospital Charge Code	853605
Hospital Revenue Code	460
Min. Negotiated Rate	$200.46
Max. Negotiated Rate	$693.90
Rate for Payer: Aetna of AZ Commercial	$693.90
Rate for Payer: Bisbee Police All Plans	$200.46
Rate for Payer: Cash Price	$616.80
Rate for Payer: Self Pay Self Pay	$616.80

Respiratory Therapy

Facility

IP

$853.00

Service Code	CPT 94060
Hospital Charge Code	884915
Hospital Revenue Code	460
Min. Negotiated Rate	$221.78
Max. Negotiated Rate	$767.70
Rate for Payer: Aetna of AZ Commercial	$767.70
Rate for Payer: Bisbee Police All Plans	$221.78
Rate for Payer: Cash Price	$682.40
Rate for Payer: Self Pay Self Pay	$682.40

RESTRAINT LIMB

Facility

IP

$19.00

Hospital Charge Code	22354291
Hospital Revenue Code	270
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Cash Price	$15.20
Rate for Payer: Self Pay Self Pay	$15.20

RESTRAINT LIMB

Facility

OP

$19.00

Hospital Charge Code	22354291
Hospital Revenue Code	270
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna of AZ Commercial	$17.10
Rate for Payer: Aetna of AZ Medicare	$5.32
Rate for Payer: Allwell Medicare	$3.04
Rate for Payer: Amerigroup Medicare	$3.04
Rate for Payer: APIPA Medicare/Medicaid	$7.10
Rate for Payer: AZCH Complete Medicare	$3.04
Rate for Payer: Banner UC Health Medicare	$3.04
Rate for Payer: Bisbee Police All Plans	$4.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.92
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cigna of AZ Commercial	$13.30
Rate for Payer: Copperpoint Commercial	$4.70
Rate for Payer: Health Net of AZ Commercial	$11.40
Rate for Payer: Health Net of AZ Medicare	$5.32
Rate for Payer: Humana of AZ Medicare	$3.04
Rate for Payer: Self Pay Self Pay	$15.20
Rate for Payer: TriWest Medicare	$3.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$11.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.42

RESUSCITATION

Facility

OP

$1,796.00

Service Code	CPT 92950
Hospital Charge Code	1886871
Hospital Revenue Code	480
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$1,616.40
Rate for Payer: Aetna of AZ Commercial	$1,616.40
Rate for Payer: Aetna of AZ Medicare	$502.88
Rate for Payer: AHCCCS Medicaid	$191.73
Rate for Payer: Allwell Medicaid	$191.73
Rate for Payer: Allwell Medicare	$287.36
Rate for Payer: Amerigroup Medicare	$287.36
Rate for Payer: APIPA Medicare/Medicaid	$670.81
Rate for Payer: AZCH Complete Medicaid	$191.73
Rate for Payer: AZCH Complete Medicare	$287.36
Rate for Payer: Banner UC Health Medicaid	$191.73
Rate for Payer: Banner UC Health Medicare	$287.36
Rate for Payer: Bisbee Police All Plans	$466.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,221.28
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cigna of AZ Commercial	$1,257.20
Rate for Payer: Copperpoint Commercial	$444.51
Rate for Payer: Health Net of AZ Commercial	$1,077.60
Rate for Payer: Health Net of AZ Medicare	$502.88
Rate for Payer: Humana of AZ Medicare	$287.36
Rate for Payer: Mercy Care Medicaid	$191.73
Rate for Payer: Self Pay Self Pay	$1,436.80
Rate for Payer: TriWest Medicare	$287.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,047.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$323.28

RESUSCITATION

Facility

IP

$1,796.00

Service Code	CPT 92950
Hospital Charge Code	1886871
Hospital Revenue Code	480
Min. Negotiated Rate	$466.96
Max. Negotiated Rate	$1,616.40
Rate for Payer: Aetna of AZ Commercial	$1,616.40
Rate for Payer: Bisbee Police All Plans	$466.96
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Self Pay Self Pay	$1,436.80

Reticulocyte Count LC

Facility

OP

$55.00

Service Code	CPT 85045
Hospital Charge Code	1909555
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.80
Rate for Payer: Amerigroup Medicare	$8.80
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.80
Rate for Payer: Banner UC Health Medicare	$8.80
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$35.75
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.80
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

Reticulocyte Count LC

Facility

IP

$55.00

Service Code	CPT 85045
Hospital Charge Code	1909555
Hospital Revenue Code	305
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

RETRACTOR BALLOON

Facility

IP

$419.00

Hospital Charge Code	22354815
Hospital Revenue Code	270
Min. Negotiated Rate	$108.94
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Bisbee Police All Plans	$108.94
Rate for Payer: Cash Price	$335.20
Rate for Payer: Self Pay Self Pay	$335.20

RETRACTOR BALLOON

Facility

OP

$419.00

Hospital Charge Code	22354815
Hospital Revenue Code	270
Min. Negotiated Rate	$67.04
Max. Negotiated Rate	$377.10
Rate for Payer: Aetna of AZ Commercial	$377.10
Rate for Payer: Aetna of AZ Medicare	$117.32
Rate for Payer: Allwell Medicare	$67.04
Rate for Payer: Amerigroup Medicare	$67.04
Rate for Payer: APIPA Medicare/Medicaid	$156.50
Rate for Payer: AZCH Complete Medicare	$67.04
Rate for Payer: Banner UC Health Medicare	$67.04
Rate for Payer: Bisbee Police All Plans	$108.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$284.92
Rate for Payer: Cash Price	$335.20
Rate for Payer: Cigna of AZ Commercial	$293.30
Rate for Payer: Copperpoint Commercial	$103.70
Rate for Payer: Health Net of AZ Commercial	$251.40
Rate for Payer: Health Net of AZ Medicare	$117.32
Rate for Payer: Humana of AZ Medicare	$67.04
Rate for Payer: Self Pay Self Pay	$335.20
Rate for Payer: TriWest Medicare	$67.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$244.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.42

RETRACTOR RING 31.8X18.3CM DISP

Facility

OP

$267.00

Hospital Charge Code	22354167
Hospital Revenue Code	270
Min. Negotiated Rate	$42.72
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Aetna of AZ Medicare	$74.76
Rate for Payer: Allwell Medicare	$42.72
Rate for Payer: Amerigroup Medicare	$42.72
Rate for Payer: APIPA Medicare/Medicaid	$99.72
Rate for Payer: AZCH Complete Medicare	$42.72
Rate for Payer: Banner UC Health Medicare	$42.72
Rate for Payer: Bisbee Police All Plans	$69.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$181.56
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cigna of AZ Commercial	$186.90
Rate for Payer: Copperpoint Commercial	$66.08
Rate for Payer: Health Net of AZ Commercial	$160.20
Rate for Payer: Health Net of AZ Medicare	$74.76
Rate for Payer: Humana of AZ Medicare	$42.72
Rate for Payer: Self Pay Self Pay	$213.60
Rate for Payer: TriWest Medicare	$42.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$155.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.06

RETRACTOR RING 31.8X18.3CM DISP

Facility

IP

$267.00

Hospital Charge Code	22354167
Hospital Revenue Code	270
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$240.30
Rate for Payer: Aetna of AZ Commercial	$240.30
Rate for Payer: Bisbee Police All Plans	$69.42
Rate for Payer: Cash Price	$213.60
Rate for Payer: Self Pay Self Pay	$213.60

RETRIEVAL TISSUE SYSTEM ANCHOR

Facility

IP

$368.00

Hospital Charge Code	22354821
Hospital Revenue Code	270
Min. Negotiated Rate	$95.68
Max. Negotiated Rate	$331.20
Rate for Payer: Aetna of AZ Commercial	$331.20
Rate for Payer: Bisbee Police All Plans	$95.68
Rate for Payer: Cash Price	$294.40
Rate for Payer: Self Pay Self Pay	$294.40

RETRIEVAL TISSUE SYSTEM ANCHOR

Facility

OP

$368.00

Hospital Charge Code	22354821
Hospital Revenue Code	270
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$331.20
Rate for Payer: Aetna of AZ Commercial	$331.20
Rate for Payer: Aetna of AZ Medicare	$103.04
Rate for Payer: Allwell Medicare	$58.88
Rate for Payer: Amerigroup Medicare	$58.88
Rate for Payer: APIPA Medicare/Medicaid	$137.45
Rate for Payer: AZCH Complete Medicare	$58.88
Rate for Payer: Banner UC Health Medicare	$58.88
Rate for Payer: Bisbee Police All Plans	$95.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$250.24
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cigna of AZ Commercial	$257.60
Rate for Payer: Copperpoint Commercial	$91.08
Rate for Payer: Health Net of AZ Commercial	$220.80
Rate for Payer: Health Net of AZ Medicare	$103.04
Rate for Payer: Humana of AZ Medicare	$58.88
Rate for Payer: Self Pay Self Pay	$294.40
Rate for Payer: TriWest Medicare	$58.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$214.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$66.24

Reverse T3 LC

Facility

IP

$359.00

Service Code	CPT 84482
Hospital Charge Code	2087649
Hospital Revenue Code	301
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$323.10
Rate for Payer: Aetna of AZ Commercial	$323.10
Rate for Payer: Bisbee Police All Plans	$93.34
Rate for Payer: Cash Price	$287.20
Rate for Payer: Self Pay Self Pay	$287.20

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