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Charge Type Setting Price  
Service Code APR-DRG 4273
Hospital Charge Code APRDRG4271
Min. Negotiated Rate $7,267.91
Max. Negotiated Rate $7,267.91
Rate for Payer: AHCCCS Medicaid $7,267.91
Rate for Payer: Allwell Medicaid $7,267.91
Rate for Payer: AZCH Complete Medicaid $7,267.91
Rate for Payer: Banner UC Health Medicaid $7,267.91
Rate for Payer: Mercy Care Medicaid $7,267.91
Service Code APR-DRG 4272
Hospital Charge Code APRDRG4273
Min. Negotiated Rate $4,531.75
Max. Negotiated Rate $4,531.75
Rate for Payer: AHCCCS Medicaid $4,531.75
Rate for Payer: Allwell Medicaid $4,531.75
Rate for Payer: AZCH Complete Medicaid $4,531.75
Rate for Payer: Banner UC Health Medicaid $4,531.75
Rate for Payer: Mercy Care Medicaid $4,531.75
Service Code APR-DRG 4274
Hospital Charge Code APRDRG4273
Min. Negotiated Rate $13,507.56
Max. Negotiated Rate $13,507.56
Rate for Payer: AHCCCS Medicaid $13,507.56
Rate for Payer: Allwell Medicaid $13,507.56
Rate for Payer: AZCH Complete Medicaid $13,507.56
Rate for Payer: Banner UC Health Medicaid $13,507.56
Rate for Payer: Mercy Care Medicaid $13,507.56
Service Code APR-DRG 4043
Hospital Charge Code APRDRG4044
Min. Negotiated Rate $16,795.72
Max. Negotiated Rate $16,795.72
Rate for Payer: AHCCCS Medicaid $16,795.72
Rate for Payer: Allwell Medicaid $16,795.72
Rate for Payer: AZCH Complete Medicaid $16,795.72
Rate for Payer: Banner UC Health Medicaid $16,795.72
Rate for Payer: Mercy Care Medicaid $16,795.72
Service Code APR-DRG 4041
Hospital Charge Code APRDRG4044
Min. Negotiated Rate $6,098.67
Max. Negotiated Rate $6,098.67
Rate for Payer: AHCCCS Medicaid $6,098.67
Rate for Payer: Allwell Medicaid $6,098.67
Rate for Payer: AZCH Complete Medicaid $6,098.67
Rate for Payer: Banner UC Health Medicaid $6,098.67
Rate for Payer: Mercy Care Medicaid $6,098.67
Service Code APR-DRG 4044
Hospital Charge Code APRDRG4042
Min. Negotiated Rate $31,813.40
Max. Negotiated Rate $31,813.40
Rate for Payer: AHCCCS Medicaid $31,813.40
Rate for Payer: Allwell Medicaid $31,813.40
Rate for Payer: AZCH Complete Medicaid $31,813.40
Rate for Payer: Banner UC Health Medicaid $31,813.40
Rate for Payer: Mercy Care Medicaid $31,813.40
Service Code APR-DRG 4041
Hospital Charge Code APRDRG4043
Min. Negotiated Rate $6,098.67
Max. Negotiated Rate $6,098.67
Rate for Payer: AHCCCS Medicaid $6,098.67
Rate for Payer: Allwell Medicaid $6,098.67
Rate for Payer: AZCH Complete Medicaid $6,098.67
Rate for Payer: Banner UC Health Medicaid $6,098.67
Rate for Payer: Mercy Care Medicaid $6,098.67
Service Code APR-DRG 4043
Hospital Charge Code APRDRG4042
Min. Negotiated Rate $16,795.72
Max. Negotiated Rate $16,795.72
Rate for Payer: AHCCCS Medicaid $16,795.72
Rate for Payer: Allwell Medicaid $16,795.72
Rate for Payer: AZCH Complete Medicaid $16,795.72
Rate for Payer: Banner UC Health Medicaid $16,795.72
Rate for Payer: Mercy Care Medicaid $16,795.72
Service Code APR-DRG 4044
Hospital Charge Code APRDRG4041
Min. Negotiated Rate $31,813.40
Max. Negotiated Rate $31,813.40
Rate for Payer: AHCCCS Medicaid $31,813.40
Rate for Payer: Allwell Medicaid $31,813.40
Rate for Payer: AZCH Complete Medicaid $31,813.40
Rate for Payer: Banner UC Health Medicaid $31,813.40
Rate for Payer: Mercy Care Medicaid $31,813.40
Service Code APR-DRG 4041
Hospital Charge Code APRDRG4041
Min. Negotiated Rate $6,098.67
Max. Negotiated Rate $6,098.67
Rate for Payer: AHCCCS Medicaid $6,098.67
Rate for Payer: Allwell Medicaid $6,098.67
Rate for Payer: AZCH Complete Medicaid $6,098.67
Rate for Payer: Banner UC Health Medicaid $6,098.67
Rate for Payer: Mercy Care Medicaid $6,098.67
Service Code APR-DRG 4042
Hospital Charge Code APRDRG4043
Min. Negotiated Rate $9,064.19
Max. Negotiated Rate $9,064.19
Rate for Payer: AHCCCS Medicaid $9,064.19
Rate for Payer: Allwell Medicaid $9,064.19
Rate for Payer: AZCH Complete Medicaid $9,064.19
Rate for Payer: Banner UC Health Medicaid $9,064.19
Rate for Payer: Mercy Care Medicaid $9,064.19
Service Code APR-DRG 4044
Hospital Charge Code APRDRG4043
Min. Negotiated Rate $31,813.40
Max. Negotiated Rate $31,813.40
Rate for Payer: AHCCCS Medicaid $31,813.40
Rate for Payer: Allwell Medicaid $31,813.40
Rate for Payer: AZCH Complete Medicaid $31,813.40
Rate for Payer: Banner UC Health Medicaid $31,813.40
Rate for Payer: Mercy Care Medicaid $31,813.40
Service Code APR-DRG 4043
Hospital Charge Code APRDRG4043
Min. Negotiated Rate $16,795.72
Max. Negotiated Rate $16,795.72
Rate for Payer: AHCCCS Medicaid $16,795.72
Rate for Payer: Allwell Medicaid $16,795.72
Rate for Payer: AZCH Complete Medicaid $16,795.72
Rate for Payer: Banner UC Health Medicaid $16,795.72
Rate for Payer: Mercy Care Medicaid $16,795.72
Service Code APR-DRG 4042
Hospital Charge Code APRDRG4042
Min. Negotiated Rate $9,064.19
Max. Negotiated Rate $9,064.19
Rate for Payer: AHCCCS Medicaid $9,064.19
Rate for Payer: Allwell Medicaid $9,064.19
Rate for Payer: AZCH Complete Medicaid $9,064.19
Rate for Payer: Banner UC Health Medicaid $9,064.19
Rate for Payer: Mercy Care Medicaid $9,064.19
Service Code APR-DRG 4044
Hospital Charge Code APRDRG4044
Min. Negotiated Rate $31,813.40
Max. Negotiated Rate $31,813.40
Rate for Payer: AHCCCS Medicaid $31,813.40
Rate for Payer: Allwell Medicaid $31,813.40
Rate for Payer: AZCH Complete Medicaid $31,813.40
Rate for Payer: Banner UC Health Medicaid $31,813.40
Rate for Payer: Mercy Care Medicaid $31,813.40
Service Code APR-DRG 4042
Hospital Charge Code APRDRG4041
Min. Negotiated Rate $9,064.19
Max. Negotiated Rate $9,064.19
Rate for Payer: AHCCCS Medicaid $9,064.19
Rate for Payer: Allwell Medicaid $9,064.19
Rate for Payer: AZCH Complete Medicaid $9,064.19
Rate for Payer: Banner UC Health Medicaid $9,064.19
Rate for Payer: Mercy Care Medicaid $9,064.19
Service Code APR-DRG 4041
Hospital Charge Code APRDRG4042
Min. Negotiated Rate $6,098.67
Max. Negotiated Rate $6,098.67
Rate for Payer: AHCCCS Medicaid $6,098.67
Rate for Payer: Allwell Medicaid $6,098.67
Rate for Payer: AZCH Complete Medicaid $6,098.67
Rate for Payer: Banner UC Health Medicaid $6,098.67
Rate for Payer: Mercy Care Medicaid $6,098.67
Service Code APR-DRG 4043
Hospital Charge Code APRDRG4041
Min. Negotiated Rate $16,795.72
Max. Negotiated Rate $16,795.72
Rate for Payer: AHCCCS Medicaid $16,795.72
Rate for Payer: Allwell Medicaid $16,795.72
Rate for Payer: AZCH Complete Medicaid $16,795.72
Rate for Payer: Banner UC Health Medicaid $16,795.72
Rate for Payer: Mercy Care Medicaid $16,795.72
Service Code APR-DRG 4042
Hospital Charge Code APRDRG4044
Min. Negotiated Rate $9,064.19
Max. Negotiated Rate $9,064.19
Rate for Payer: AHCCCS Medicaid $9,064.19
Rate for Payer: Allwell Medicaid $9,064.19
Rate for Payer: AZCH Complete Medicaid $9,064.19
Rate for Payer: Banner UC Health Medicaid $9,064.19
Rate for Payer: Mercy Care Medicaid $9,064.19
Service Code CPT 86376
Hospital Charge Code 22481507
Hospital Revenue Code 302
Min. Negotiated Rate $63.44
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Cash Price $195.20
Rate for Payer: Self Pay Self Pay $195.20
Service Code CPT 86376
Hospital Charge Code 22481507
Hospital Revenue Code 302
Min. Negotiated Rate $14.55
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Aetna of AZ Medicare $68.32
Rate for Payer: AHCCCS Medicaid $14.55
Rate for Payer: Allwell Medicaid $14.55
Rate for Payer: Allwell Medicare $36.60
Rate for Payer: Amerigroup Medicare $36.60
Rate for Payer: APIPA Medicare/Medicaid $91.13
Rate for Payer: AZCH Complete Medicaid $14.55
Rate for Payer: AZCH Complete Medicare $36.60
Rate for Payer: Banner UC Health Medicaid $14.55
Rate for Payer: Banner UC Health Medicare $36.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $165.92
Rate for Payer: Cash Price $195.20
Rate for Payer: Cash Price $195.20
Rate for Payer: Cigna of AZ Commercial $158.60
Rate for Payer: Copperpoint Commercial $60.39
Rate for Payer: Health Net of AZ Commercial $146.40
Rate for Payer: Health Net of AZ Medicare $68.32
Rate for Payer: Humana of AZ Medicare $36.60
Rate for Payer: Mercy Care Medicaid $14.55
Rate for Payer: Self Pay Self Pay $195.20
Rate for Payer: TriWest Medicare $36.60
Rate for Payer: UnitedHealth Group of AZ Commercial $142.25
Rate for Payer: UnitedHealth Group of AZ Medicare $43.92
Service Code CPT 86376
Hospital Charge Code 22531070
Hospital Revenue Code 301
Min. Negotiated Rate $14.55
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Aetna of AZ Medicare $68.32
Rate for Payer: AHCCCS Medicaid $14.55
Rate for Payer: Allwell Medicaid $14.55
Rate for Payer: Allwell Medicare $36.60
Rate for Payer: Amerigroup Medicare $36.60
Rate for Payer: APIPA Medicare/Medicaid $91.13
Rate for Payer: AZCH Complete Medicaid $14.55
Rate for Payer: AZCH Complete Medicare $36.60
Rate for Payer: Banner UC Health Medicaid $14.55
Rate for Payer: Banner UC Health Medicare $36.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $165.92
Rate for Payer: Cash Price $195.20
Rate for Payer: Cash Price $195.20
Rate for Payer: Cigna of AZ Commercial $158.60
Rate for Payer: Copperpoint Commercial $60.39
Rate for Payer: Health Net of AZ Commercial $146.40
Rate for Payer: Health Net of AZ Medicare $68.32
Rate for Payer: Humana of AZ Medicare $36.60
Rate for Payer: Mercy Care Medicaid $14.55
Rate for Payer: Self Pay Self Pay $195.20
Rate for Payer: TriWest Medicare $36.60
Rate for Payer: UnitedHealth Group of AZ Commercial $142.25
Rate for Payer: UnitedHealth Group of AZ Medicare $43.92
Service Code CPT 86376
Hospital Charge Code 22531070
Hospital Revenue Code 301
Min. Negotiated Rate $63.44
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Cash Price $195.20
Rate for Payer: Self Pay Self Pay $195.20
Service Code CPT 86376
Hospital Charge Code 1285786
Hospital Revenue Code 302
Min. Negotiated Rate $14.55
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Aetna of AZ Medicare $68.32
Rate for Payer: AHCCCS Medicaid $14.55
Rate for Payer: Allwell Medicaid $14.55
Rate for Payer: Allwell Medicare $36.60
Rate for Payer: Amerigroup Medicare $36.60
Rate for Payer: APIPA Medicare/Medicaid $91.13
Rate for Payer: AZCH Complete Medicaid $14.55
Rate for Payer: AZCH Complete Medicare $36.60
Rate for Payer: Banner UC Health Medicaid $14.55
Rate for Payer: Banner UC Health Medicare $36.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial $165.92
Rate for Payer: Cash Price $195.20
Rate for Payer: Cash Price $195.20
Rate for Payer: Cigna of AZ Commercial $158.60
Rate for Payer: Copperpoint Commercial $60.39
Rate for Payer: Health Net of AZ Commercial $146.40
Rate for Payer: Health Net of AZ Medicare $68.32
Rate for Payer: Humana of AZ Medicare $36.60
Rate for Payer: Mercy Care Medicaid $14.55
Rate for Payer: Self Pay Self Pay $195.20
Rate for Payer: TriWest Medicare $36.60
Rate for Payer: UnitedHealth Group of AZ Commercial $142.25
Rate for Payer: UnitedHealth Group of AZ Medicare $43.92
Service Code CPT 86376
Hospital Charge Code 1285786
Hospital Revenue Code 302
Min. Negotiated Rate $63.44
Max. Negotiated Rate $219.60
Rate for Payer: Aetna of AZ Commercial $219.60
Rate for Payer: Bisbee Police All Plans $63.44
Rate for Payer: Cash Price $195.20
Rate for Payer: Self Pay Self Pay $195.20