Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: AHCCCS Medicaid	$5,035.35
Rate for Payer: Allwell Medicaid	$5,035.35
Rate for Payer: AZCH Complete Medicaid	$5,035.35
Rate for Payer: Banner UC Health Medicaid	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: AHCCCS Medicaid	$10,319.70
Rate for Payer: Allwell Medicaid	$10,319.70
Rate for Payer: AZCH Complete Medicaid	$10,319.70
Rate for Payer: Banner UC Health Medicaid	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: AHCCCS Medicaid	$5,035.35
Rate for Payer: Allwell Medicaid	$5,035.35
Rate for Payer: AZCH Complete Medicaid	$5,035.35
Rate for Payer: Banner UC Health Medicaid	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: AHCCCS Medicaid	$5,035.35
Rate for Payer: Allwell Medicaid	$5,035.35
Rate for Payer: AZCH Complete Medicaid	$5,035.35
Rate for Payer: Banner UC Health Medicaid	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: AHCCCS Medicaid	$5,035.35
Rate for Payer: Allwell Medicaid	$5,035.35
Rate for Payer: AZCH Complete Medicaid	$5,035.35
Rate for Payer: Banner UC Health Medicaid	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: AHCCCS Medicaid	$10,319.70
Rate for Payer: Allwell Medicaid	$10,319.70
Rate for Payer: AZCH Complete Medicaid	$10,319.70
Rate for Payer: Banner UC Health Medicaid	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: AHCCCS Medicaid	$10,319.70
Rate for Payer: Allwell Medicaid	$10,319.70
Rate for Payer: AZCH Complete Medicaid	$10,319.70
Rate for Payer: Banner UC Health Medicaid	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: AHCCCS Medicaid	$10,319.70
Rate for Payer: Allwell Medicaid	$10,319.70
Rate for Payer: AZCH Complete Medicaid	$10,319.70
Rate for Payer: Banner UC Health Medicaid	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: AHCCCS Medicaid	$3,952.39
Rate for Payer: Allwell Medicaid	$3,952.39
Rate for Payer: AZCH Complete Medicaid	$3,952.39
Rate for Payer: Banner UC Health Medicaid	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39

Toxoplasma gondii Ab, IgG, Qn LC

Facility

OP

$181.00

Service Code	CPT 86777
Hospital Charge Code	7328613
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
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: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
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 Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.39
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: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
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: Mercy Care Medicaid	$14.39
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

Toxoplasma gondii Ab, IgG, Qn LC

Facility

IP

$181.00

Service Code	CPT 86777
Hospital Charge Code	7328613
Hospital Revenue Code	302
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

.Toxoplasma gondii Ab, IgM, Comment LC

Facility

IP

$181.00

Service Code	CPT 86777
Hospital Charge Code	22311169
Hospital Revenue Code	301
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

.Toxoplasma gondii Ab, IgM, Comment LC

Facility

OP

$181.00

Service Code	CPT 86777
Hospital Charge Code	22311169
Hospital Revenue Code	301
Min. Negotiated Rate	$14.39
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: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
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 Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.39
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: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
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: Mercy Care Medicaid	$14.39
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

Toxoplasma gondii IgM Ab LC

Facility

OP

$190.00

Service Code	CPT 86778
Hospital Charge Code	6782185
Hospital Revenue Code	302
Min. Negotiated Rate	$14.41
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Aetna of AZ Medicare	$53.20
Rate for Payer: AHCCCS Medicaid	$14.41
Rate for Payer: Allwell Medicaid	$14.41
Rate for Payer: Allwell Medicare	$28.50
Rate for Payer: Amerigroup Medicare	$28.50
Rate for Payer: APIPA Medicare/Medicaid	$70.96
Rate for Payer: AZCH Complete Medicaid	$14.41
Rate for Payer: AZCH Complete Medicare	$28.50
Rate for Payer: Banner UC Health Medicaid	$14.41
Rate for Payer: Banner UC Health Medicare	$28.50
Rate for Payer: Bisbee Police All Plans	$49.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$129.20
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cigna of AZ Commercial	$123.50
Rate for Payer: Copperpoint Commercial	$47.02
Rate for Payer: Health Net of AZ Commercial	$114.00
Rate for Payer: Health Net of AZ Medicare	$53.20
Rate for Payer: Humana of AZ Medicare	$28.50
Rate for Payer: Mercy Care Medicaid	$14.41
Rate for Payer: Self Pay Self Pay	$152.00
Rate for Payer: TriWest Medicare	$28.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$110.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.20

Toxoplasma gondii IgM Ab LC

Facility

IP

$190.00

Service Code	CPT 86778
Hospital Charge Code	6782185
Hospital Revenue Code	302
Min. Negotiated Rate	$49.40
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna of AZ Commercial	$171.00
Rate for Payer: Bisbee Police All Plans	$49.40
Rate for Payer: Cash Price	$152.00
Rate for Payer: Self Pay Self Pay	$152.00

T pallidum Ab (FTA-Ab) LC

Facility

OP

$205.00

Service Code	CPT 86780
Hospital Charge Code	2270018
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Aetna of AZ Medicare	$57.40
Rate for Payer: AHCCCS Medicaid	$13.24
Rate for Payer: Allwell Medicaid	$13.24
Rate for Payer: Allwell Medicare	$30.75
Rate for Payer: Amerigroup Medicare	$30.75
Rate for Payer: APIPA Medicare/Medicaid	$76.57
Rate for Payer: AZCH Complete Medicaid	$13.24
Rate for Payer: AZCH Complete Medicare	$30.75
Rate for Payer: Banner UC Health Medicaid	$13.24
Rate for Payer: Banner UC Health Medicare	$30.75
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$139.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cigna of AZ Commercial	$133.25
Rate for Payer: Copperpoint Commercial	$50.74
Rate for Payer: Health Net of AZ Commercial	$123.00
Rate for Payer: Health Net of AZ Medicare	$57.40
Rate for Payer: Humana of AZ Medicare	$30.75
Rate for Payer: Mercy Care Medicaid	$13.24
Rate for Payer: Self Pay Self Pay	$164.00
Rate for Payer: TriWest Medicare	$30.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$119.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.90

T pallidum Ab (FTA-Ab) LC

Facility

IP

$205.00

Service Code	CPT 86780
Hospital Charge Code	2270018
Hospital Revenue Code	302
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna of AZ Commercial	$184.50
Rate for Payer: Bisbee Police All Plans	$53.30
Rate for Payer: Cash Price	$164.00
Rate for Payer: Self Pay Self Pay	$164.00

TPMT Genetic Test LC

Facility

OP

$1,788.00

Service Code	CPT 81401
Hospital Charge Code	22348727
Hospital Revenue Code	301
Min. Negotiated Rate	$137.00
Max. Negotiated Rate	$1,609.20
Rate for Payer: Aetna of AZ Commercial	$1,609.20
Rate for Payer: Aetna of AZ Medicare	$500.64
Rate for Payer: AHCCCS Medicaid	$137.00
Rate for Payer: Allwell Medicaid	$137.00
Rate for Payer: Allwell Medicare	$268.20
Rate for Payer: Amerigroup Medicare	$268.20
Rate for Payer: APIPA Medicare/Medicaid	$667.82
Rate for Payer: AZCH Complete Medicaid	$137.00
Rate for Payer: AZCH Complete Medicare	$268.20
Rate for Payer: Banner UC Health Medicaid	$137.00
Rate for Payer: Banner UC Health Medicare	$268.20
Rate for Payer: Bisbee Police All Plans	$464.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,215.84
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Cigna of AZ Commercial	$1,162.20
Rate for Payer: Copperpoint Commercial	$442.53
Rate for Payer: Health Net of AZ Commercial	$1,072.80
Rate for Payer: Health Net of AZ Medicare	$500.64
Rate for Payer: Humana of AZ Medicare	$268.20
Rate for Payer: Mercy Care Medicaid	$137.00
Rate for Payer: Self Pay Self Pay	$1,430.40
Rate for Payer: TriWest Medicare	$268.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,042.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$321.84

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