Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$8,805.38

Service Code	APR-DRG 3172
Hospital Charge Code	APRDRG3171
Min. Negotiated Rate	$8,805.38
Max. Negotiated Rate	$8,805.38
Rate for Payer: AHCCCS Medicaid	$8,805.38
Rate for Payer: Allwell Medicaid	$8,805.38
Rate for Payer: AZCH Complete Medicaid	$8,805.38
Rate for Payer: Banner UC Health Medicaid	$8,805.38
Rate for Payer: Mercy Care Medicaid	$8,805.38

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$14,282.61

Service Code	APR-DRG 3173
Hospital Charge Code	APRDRG3174
Min. Negotiated Rate	$14,282.61
Max. Negotiated Rate	$14,282.61
Rate for Payer: AHCCCS Medicaid	$14,282.61
Rate for Payer: Allwell Medicaid	$14,282.61
Rate for Payer: AZCH Complete Medicaid	$14,282.61
Rate for Payer: Banner UC Health Medicaid	$14,282.61
Rate for Payer: Mercy Care Medicaid	$14,282.61

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$27,861.71

Service Code	APR-DRG 3174
Hospital Charge Code	APRDRG3174
Min. Negotiated Rate	$27,861.71
Max. Negotiated Rate	$27,861.71
Rate for Payer: AHCCCS Medicaid	$27,861.71
Rate for Payer: Allwell Medicaid	$27,861.71
Rate for Payer: AZCH Complete Medicaid	$27,861.71
Rate for Payer: Banner UC Health Medicaid	$27,861.71
Rate for Payer: Mercy Care Medicaid	$27,861.71

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$27,861.71

Service Code	APR-DRG 3174
Hospital Charge Code	APRDRG3173
Min. Negotiated Rate	$27,861.71
Max. Negotiated Rate	$27,861.71
Rate for Payer: AHCCCS Medicaid	$27,861.71
Rate for Payer: Allwell Medicaid	$27,861.71
Rate for Payer: AZCH Complete Medicaid	$27,861.71
Rate for Payer: Banner UC Health Medicaid	$27,861.71
Rate for Payer: Mercy Care Medicaid	$27,861.71

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$8,805.38

Service Code	APR-DRG 3172
Hospital Charge Code	APRDRG3174
Min. Negotiated Rate	$8,805.38
Max. Negotiated Rate	$8,805.38
Rate for Payer: AHCCCS Medicaid	$8,805.38
Rate for Payer: Allwell Medicaid	$8,805.38
Rate for Payer: AZCH Complete Medicaid	$8,805.38
Rate for Payer: Banner UC Health Medicaid	$8,805.38
Rate for Payer: Mercy Care Medicaid	$8,805.38

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$6,375.02

Service Code	APR-DRG 3171
Hospital Charge Code	APRDRG3171
Min. Negotiated Rate	$6,375.02
Max. Negotiated Rate	$6,375.02
Rate for Payer: AHCCCS Medicaid	$6,375.02
Rate for Payer: Allwell Medicaid	$6,375.02
Rate for Payer: AZCH Complete Medicaid	$6,375.02
Rate for Payer: Banner UC Health Medicaid	$6,375.02
Rate for Payer: Mercy Care Medicaid	$6,375.02

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$8,805.38

Service Code	APR-DRG 3172
Hospital Charge Code	APRDRG3173
Min. Negotiated Rate	$8,805.38
Max. Negotiated Rate	$8,805.38
Rate for Payer: AHCCCS Medicaid	$8,805.38
Rate for Payer: Allwell Medicaid	$8,805.38
Rate for Payer: AZCH Complete Medicaid	$8,805.38
Rate for Payer: Banner UC Health Medicaid	$8,805.38
Rate for Payer: Mercy Care Medicaid	$8,805.38

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$6,375.02

Service Code	APR-DRG 3171
Hospital Charge Code	APRDRG3172
Min. Negotiated Rate	$6,375.02
Max. Negotiated Rate	$6,375.02
Rate for Payer: AHCCCS Medicaid	$6,375.02
Rate for Payer: Allwell Medicaid	$6,375.02
Rate for Payer: AZCH Complete Medicaid	$6,375.02
Rate for Payer: Banner UC Health Medicaid	$6,375.02
Rate for Payer: Mercy Care Medicaid	$6,375.02

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$8,805.38

Service Code	APR-DRG 3172
Hospital Charge Code	APRDRG3172
Min. Negotiated Rate	$8,805.38
Max. Negotiated Rate	$8,805.38
Rate for Payer: AHCCCS Medicaid	$8,805.38
Rate for Payer: Allwell Medicaid	$8,805.38
Rate for Payer: AZCH Complete Medicaid	$8,805.38
Rate for Payer: Banner UC Health Medicaid	$8,805.38
Rate for Payer: Mercy Care Medicaid	$8,805.38

Tendon, Muscle And Other Soft Tissue Procedures

Facility

IP

$14,282.61

Service Code	APR-DRG 3173
Hospital Charge Code	APRDRG3171
Min. Negotiated Rate	$14,282.61
Max. Negotiated Rate	$14,282.61
Rate for Payer: AHCCCS Medicaid	$14,282.61
Rate for Payer: Allwell Medicaid	$14,282.61
Rate for Payer: AZCH Complete Medicaid	$14,282.61
Rate for Payer: Banner UC Health Medicaid	$14,282.61
Rate for Payer: Mercy Care Medicaid	$14,282.61

tenecteplase 50 mg REC inj[CQCH]

Facility

IP

$7,158.34

Service Code	HCPCS J3101
Hospital Charge Code	242057163
Hospital Revenue Code	636
Min. Negotiated Rate	$1,861.17
Max. Negotiated Rate	$6,442.51
Rate for Payer: Aetna of AZ Commercial	$6,442.51
Rate for Payer: Bisbee Police All Plans	$1,861.17
Rate for Payer: Cash Price	$5,726.67
Rate for Payer: Self Pay Self Pay	$5,726.67

tenecteplase 50 mg REC inj[CQCH]

Facility

OP

$7,158.34

Service Code	HCPCS J3101
Hospital Charge Code	242057163
Hospital Revenue Code	636
Min. Negotiated Rate	$1,145.33
Max. Negotiated Rate	$6,442.51
Rate for Payer: Aetna of AZ Commercial	$6,442.51
Rate for Payer: Aetna of AZ Medicare	$2,004.34
Rate for Payer: Allwell Medicare	$1,145.33
Rate for Payer: Amerigroup Medicare	$1,145.33
Rate for Payer: APIPA Medicare/Medicaid	$2,673.64
Rate for Payer: AZCH Complete Medicare	$1,145.33
Rate for Payer: Banner UC Health Medicare	$1,145.33
Rate for Payer: Bisbee Police All Plans	$1,861.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,867.67
Rate for Payer: Cash Price	$5,726.67
Rate for Payer: Cigna of AZ Commercial	$5,010.84
Rate for Payer: Copperpoint Commercial	$1,771.69
Rate for Payer: Health Net of AZ Commercial	$4,295.00
Rate for Payer: Health Net of AZ Medicare	$2,004.34
Rate for Payer: Humana of AZ Medicare	$1,145.33
Rate for Payer: Self Pay Self Pay	$5,726.67
Rate for Payer: TriWest Medicare	$1,145.33
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,173.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,288.50

Tensoplast 6in

Facility

IP

$45.00

Hospital Charge Code	22926425
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Cash Price	$36.00
Rate for Payer: Self Pay Self Pay	$36.00

Tensoplast 6in

Facility

OP

$45.00

Hospital Charge Code	22926425
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

terazosin 1 mg Cap [CQCH]

Facility

OP

$0.12

Service Code	NDC 904612661
Hospital Charge Code	105943313
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.08
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

terazosin 1 mg Cap [CQCH]

Facility

IP

$0.12

Service Code	NDC 904612661
Hospital Charge Code	105943313
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

terazosin 5 mg Cap [CQCH]

Facility

IP

$0.13

Service Code	NDC 51079093820
Hospital Charge Code	105943248
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

terazosin 5 mg Cap [CQCH]

Facility

OP

$0.13

Service Code	NDC 51079093820
Hospital Charge Code	105943248
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

terbutaline 1 mg/1 mL Inj Sol [CQCH]

Facility

IP

$1.07

Service Code	HCPCS J3105
Hospital Charge Code	105943380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of AZ Commercial	$0.96
Rate for Payer: Bisbee Police All Plans	$0.28
Rate for Payer: Cash Price	$0.86
Rate for Payer: Self Pay Self Pay	$0.86

terbutaline 1 mg/1 mL Inj Sol [CQCH]

Facility

OP

$1.07

Service Code	HCPCS J3105
Hospital Charge Code	105943380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of AZ Commercial	$0.96
Rate for Payer: Aetna of AZ Medicare	$0.30
Rate for Payer: Allwell Medicare	$0.17
Rate for Payer: Amerigroup Medicare	$0.17
Rate for Payer: APIPA Medicare/Medicaid	$0.40
Rate for Payer: AZCH Complete Medicare	$0.17
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Bisbee Police All Plans	$0.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.73
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cigna of AZ Commercial	$0.70
Rate for Payer: Copperpoint Commercial	$0.26
Rate for Payer: Health Net of AZ Commercial	$0.64
Rate for Payer: Health Net of AZ Medicare	$0.30
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Self Pay Self Pay	$0.86
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.19

TEST FOR DETECTING 3 BIOMARKERS ASSOCIATED WITH RISK FOR LIV

Facility

IP

$880.00

Service Code	CPT 81517
Hospital Charge Code	28011458
Hospital Revenue Code	302
Min. Negotiated Rate	$228.80
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Bisbee Police All Plans	$228.80
Rate for Payer: Cash Price	$704.00
Rate for Payer: Self Pay Self Pay	$704.00

TEST FOR DETECTING 3 BIOMARKERS ASSOCIATED WITH RISK FOR LIV

Facility

OP

$880.00

Service Code	CPT 81517
Hospital Charge Code	28011458
Hospital Revenue Code	302
Min. Negotiated Rate	$140.80
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna of AZ Commercial	$792.00
Rate for Payer: Aetna of AZ Medicare	$246.40
Rate for Payer: Allwell Medicare	$140.80
Rate for Payer: Amerigroup Medicare	$140.80
Rate for Payer: APIPA Medicare/Medicaid	$328.68
Rate for Payer: AZCH Complete Medicare	$140.80
Rate for Payer: Banner UC Health Medicare	$140.80
Rate for Payer: Bisbee Police All Plans	$228.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$598.40
Rate for Payer: Cash Price	$704.00
Rate for Payer: Cigna of AZ Commercial	$572.00
Rate for Payer: Copperpoint Commercial	$217.80
Rate for Payer: Health Net of AZ Commercial	$528.00
Rate for Payer: Health Net of AZ Medicare	$246.40
Rate for Payer: Humana of AZ Medicare	$140.80
Rate for Payer: Self Pay Self Pay	$704.00
Rate for Payer: TriWest Medicare	$140.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$513.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$158.40

Testosterone, Free, Direct LC

Facility

IP

$302.00

Service Code	CPT 84402
Hospital Charge Code	1905846
Hospital Revenue Code	301
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

Testosterone, Free, Direct LC

Facility

OP

$302.00

Service Code	CPT 84402
Hospital Charge Code	1905846
Hospital Revenue Code	301
Min. Negotiated Rate	$48.32
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$48.32
Rate for Payer: Amerigroup Medicare	$48.32
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$48.32
Rate for Payer: Banner UC Health Medicare	$48.32
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$196.30
Rate for Payer: Copperpoint Commercial	$74.75
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$48.32
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$48.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

Testosterone, Serum LC

Facility

OP

$321.00

Service Code	CPT 84403
Hospital Charge Code	1285542
Hospital Revenue Code	301
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$288.90
Rate for Payer: Aetna of AZ Commercial	$288.90
Rate for Payer: Aetna of AZ Medicare	$89.88
Rate for Payer: Allwell Medicare	$51.36
Rate for Payer: Amerigroup Medicare	$51.36
Rate for Payer: APIPA Medicare/Medicaid	$119.89
Rate for Payer: AZCH Complete Medicare	$51.36
Rate for Payer: Banner UC Health Medicare	$51.36
Rate for Payer: Bisbee Police All Plans	$83.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.28
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cigna of AZ Commercial	$208.65
Rate for Payer: Copperpoint Commercial	$79.45
Rate for Payer: Health Net of AZ Commercial	$192.60
Rate for Payer: Health Net of AZ Medicare	$89.88
Rate for Payer: Humana of AZ Medicare	$51.36
Rate for Payer: Self Pay Self Pay	$256.80
Rate for Payer: TriWest Medicare	$51.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.78

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