Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$12,378.31

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG4654
Min. Negotiated Rate	$12,378.31
Max. Negotiated Rate	$12,378.31
Rate for Payer: AHCCCS Medicaid	$12,378.31
Rate for Payer: Allwell Medicaid	$12,378.31
Rate for Payer: AZCH Complete Medicaid	$12,378.31
Rate for Payer: Banner UC Health Medicaid	$12,378.31
Rate for Payer: Mercy Care Medicaid	$12,378.31

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$3,523.83

Service Code	APR-DRG 4651
Hospital Charge Code	APRDRG4653
Min. Negotiated Rate	$3,523.83
Max. Negotiated Rate	$3,523.83
Rate for Payer: AHCCCS Medicaid	$3,523.83
Rate for Payer: Allwell Medicaid	$3,523.83
Rate for Payer: AZCH Complete Medicaid	$3,523.83
Rate for Payer: Banner UC Health Medicaid	$3,523.83
Rate for Payer: Mercy Care Medicaid	$3,523.83

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$4,278.54

Service Code	APR-DRG 4652
Hospital Charge Code	APRDRG4654
Min. Negotiated Rate	$4,278.54
Max. Negotiated Rate	$4,278.54
Rate for Payer: AHCCCS Medicaid	$4,278.54
Rate for Payer: Allwell Medicaid	$4,278.54
Rate for Payer: AZCH Complete Medicaid	$4,278.54
Rate for Payer: Banner UC Health Medicaid	$4,278.54
Rate for Payer: Mercy Care Medicaid	$4,278.54

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$4,278.54

Service Code	APR-DRG 4652
Hospital Charge Code	APRDRG4653
Min. Negotiated Rate	$4,278.54
Max. Negotiated Rate	$4,278.54
Rate for Payer: AHCCCS Medicaid	$4,278.54
Rate for Payer: Allwell Medicaid	$4,278.54
Rate for Payer: AZCH Complete Medicaid	$4,278.54
Rate for Payer: Banner UC Health Medicaid	$4,278.54
Rate for Payer: Mercy Care Medicaid	$4,278.54

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$12,378.31

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG4653
Min. Negotiated Rate	$12,378.31
Max. Negotiated Rate	$12,378.31
Rate for Payer: AHCCCS Medicaid	$12,378.31
Rate for Payer: Allwell Medicaid	$12,378.31
Rate for Payer: AZCH Complete Medicaid	$12,378.31
Rate for Payer: Banner UC Health Medicaid	$12,378.31
Rate for Payer: Mercy Care Medicaid	$12,378.31

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$6,990.85

Service Code	APR-DRG 4653
Hospital Charge Code	APRDRG4651
Min. Negotiated Rate	$6,990.85
Max. Negotiated Rate	$6,990.85
Rate for Payer: AHCCCS Medicaid	$6,990.85
Rate for Payer: Allwell Medicaid	$6,990.85
Rate for Payer: AZCH Complete Medicaid	$6,990.85
Rate for Payer: Banner UC Health Medicaid	$6,990.85
Rate for Payer: Mercy Care Medicaid	$6,990.85

Urinary Stones And Acquired Upper Urinary Tract Obstruction

Facility

IP

$4,278.54

Service Code	APR-DRG 4652
Hospital Charge Code	APRDRG4652
Min. Negotiated Rate	$4,278.54
Max. Negotiated Rate	$4,278.54
Rate for Payer: AHCCCS Medicaid	$4,278.54
Rate for Payer: Allwell Medicaid	$4,278.54
Rate for Payer: AZCH Complete Medicaid	$4,278.54
Rate for Payer: Banner UC Health Medicaid	$4,278.54
Rate for Payer: Mercy Care Medicaid	$4,278.54

Urine Culture

Facility

OP

$173.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Aetna of AZ Medicare	$48.44
Rate for Payer: AHCCCS Medicaid	$8.07
Rate for Payer: Allwell Medicaid	$8.07
Rate for Payer: Allwell Medicare	$25.95
Rate for Payer: Amerigroup Medicare	$25.95
Rate for Payer: APIPA Medicare/Medicaid	$64.62
Rate for Payer: AZCH Complete Medicaid	$8.07
Rate for Payer: AZCH Complete Medicare	$25.95
Rate for Payer: Banner UC Health Medicaid	$8.07
Rate for Payer: Banner UC Health Medicare	$25.95
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$117.64
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cigna of AZ Commercial	$112.45
Rate for Payer: Copperpoint Commercial	$42.82
Rate for Payer: Health Net of AZ Commercial	$103.80
Rate for Payer: Health Net of AZ Medicare	$48.44
Rate for Payer: Humana of AZ Medicare	$25.95
Rate for Payer: Mercy Care Medicaid	$8.07
Rate for Payer: Self Pay Self Pay	$138.40
Rate for Payer: TriWest Medicare	$25.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.14

Urine Culture

Facility

IP

$173.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$155.70
Rate for Payer: Aetna of AZ Commercial	$155.70
Rate for Payer: Bisbee Police All Plans	$44.98
Rate for Payer: Cash Price	$138.40
Rate for Payer: Self Pay Self Pay	$138.40

Urine Drug Screen Standard

Facility

IP

$774.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$201.24
Max. Negotiated Rate	$696.60
Rate for Payer: Aetna of AZ Commercial	$696.60
Rate for Payer: Bisbee Police All Plans	$201.24
Rate for Payer: Cash Price	$619.20
Rate for Payer: Self Pay Self Pay	$619.20

Urine Drug Screen Standard

Facility

OP

$774.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$696.60
Rate for Payer: Aetna of AZ Commercial	$696.60
Rate for Payer: Aetna of AZ Medicare	$216.72
Rate for Payer: AHCCCS Medicaid	$62.14
Rate for Payer: Allwell Medicaid	$62.14
Rate for Payer: Allwell Medicare	$116.10
Rate for Payer: Amerigroup Medicare	$116.10
Rate for Payer: APIPA Medicare/Medicaid	$289.09
Rate for Payer: AZCH Complete Medicaid	$62.14
Rate for Payer: AZCH Complete Medicare	$116.10
Rate for Payer: Banner UC Health Medicaid	$62.14
Rate for Payer: Banner UC Health Medicare	$116.10
Rate for Payer: Bisbee Police All Plans	$201.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$526.32
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cigna of AZ Commercial	$503.10
Rate for Payer: Copperpoint Commercial	$191.56
Rate for Payer: Health Net of AZ Commercial	$464.40
Rate for Payer: Health Net of AZ Medicare	$216.72
Rate for Payer: Humana of AZ Medicare	$116.10
Rate for Payer: Mercy Care Medicaid	$62.14
Rate for Payer: Self Pay Self Pay	$619.20
Rate for Payer: TriWest Medicare	$116.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$451.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$139.32

URINE METER DRAIN BAG

Facility

OP

$38.00

Hospital Charge Code	22355000
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Aetna of AZ Medicare	$10.64
Rate for Payer: Allwell Medicare	$5.70
Rate for Payer: Amerigroup Medicare	$5.70
Rate for Payer: APIPA Medicare/Medicaid	$14.19
Rate for Payer: AZCH Complete Medicare	$5.70
Rate for Payer: Banner UC Health Medicare	$5.70
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$25.84
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cigna of AZ Commercial	$26.60
Rate for Payer: Copperpoint Commercial	$9.40
Rate for Payer: Health Net of AZ Commercial	$22.80
Rate for Payer: Health Net of AZ Medicare	$10.64
Rate for Payer: Humana of AZ Medicare	$5.70
Rate for Payer: Self Pay Self Pay	$30.40
Rate for Payer: TriWest Medicare	$5.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.84

URINE METER DRAIN BAG

Facility

IP

$38.00

Hospital Charge Code	22355000
Hospital Revenue Code	270
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna of AZ Commercial	$34.20
Rate for Payer: Bisbee Police All Plans	$9.88
Rate for Payer: Cash Price	$30.40
Rate for Payer: Self Pay Self Pay	$30.40

Urine Pregnancy Test POC

Facility

OP

$159.00

Service Code	CPT 81025 QW
Hospital Charge Code	607621
Hospital Revenue Code	300
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$23.85
Rate for Payer: Amerigroup Medicare	$23.85
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$23.85
Rate for Payer: Banner UC Health Medicare	$23.85
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$23.85
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$23.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

Urine Pregnancy Test POC

Facility

IP

$159.00

Service Code	CPT 81025 QW
Hospital Charge Code	607621
Hospital Revenue Code	300
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

Urine Volume

Facility

IP

$49.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

Urine Volume

Facility

OP

$49.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Aetna of AZ Medicare	$13.72
Rate for Payer: AHCCCS Medicaid	$3.64
Rate for Payer: Allwell Medicaid	$3.64
Rate for Payer: Allwell Medicare	$7.35
Rate for Payer: Amerigroup Medicare	$7.35
Rate for Payer: APIPA Medicare/Medicaid	$18.30
Rate for Payer: AZCH Complete Medicaid	$3.64
Rate for Payer: AZCH Complete Medicare	$7.35
Rate for Payer: Banner UC Health Medicaid	$3.64
Rate for Payer: Banner UC Health Medicare	$7.35
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$33.32
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cigna of AZ Commercial	$31.85
Rate for Payer: Copperpoint Commercial	$12.13
Rate for Payer: Health Net of AZ Commercial	$29.40
Rate for Payer: Health Net of AZ Medicare	$13.72
Rate for Payer: Humana of AZ Medicare	$7.35
Rate for Payer: Mercy Care Medicaid	$3.64
Rate for Payer: Self Pay Self Pay	$39.20
Rate for Payer: TriWest Medicare	$7.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.82

Uroflowmetry- Complex

Facility

OP

$79.00

Service Code	CPT 51741
Hospital Charge Code	27291783
Hospital Revenue Code	360
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Aetna of AZ Medicare	$22.12
Rate for Payer: AHCCCS Medicaid	$202.34
Rate for Payer: Allwell Medicaid	$202.34
Rate for Payer: Allwell Medicare	$11.85
Rate for Payer: Amerigroup Medicare	$11.85
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicaid	$202.34
Rate for Payer: AZCH Complete Medicare	$11.85
Rate for Payer: Banner UC Health Medicaid	$202.34
Rate for Payer: Banner UC Health Medicare	$11.85
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.72
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$39.50
Rate for Payer: Copperpoint Commercial	$19.55
Rate for Payer: Health Net of AZ Commercial	$47.40
Rate for Payer: Health Net of AZ Medicare	$22.12
Rate for Payer: Humana of AZ Medicare	$11.85
Rate for Payer: Mercy Care Medicaid	$202.34
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$11.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

Uroflowmetry- Complex

Facility

IP

$79.00

Service Code	CPT 51741
Hospital Charge Code	27291783
Hospital Revenue Code	360
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Cash Price	$63.20
Rate for Payer: Self Pay Self Pay	$63.20

US Abdomen Complete

Facility

IP

$1,552.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$403.52
Max. Negotiated Rate	$1,396.80
Rate for Payer: Aetna of AZ Commercial	$1,396.80
Rate for Payer: Bisbee Police All Plans	$403.52
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Self Pay Self Pay	$1,241.60

US Abdomen Complete

Facility

OP

$1,552.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$1,396.80
Rate for Payer: Aetna of AZ Commercial	$1,396.80
Rate for Payer: Aetna of AZ Medicare	$434.56
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$232.80
Rate for Payer: Amerigroup Medicare	$232.80
Rate for Payer: APIPA Medicare/Medicaid	$579.67
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$232.80
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$232.80
Rate for Payer: Bisbee Police All Plans	$403.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,055.36
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Cash Price	$1,241.60
Rate for Payer: Cigna of AZ Commercial	$1,086.40
Rate for Payer: Copperpoint Commercial	$384.12
Rate for Payer: Health Net of AZ Commercial	$931.20
Rate for Payer: Health Net of AZ Medicare	$434.56
Rate for Payer: Humana of AZ Medicare	$232.80
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$1,241.60
Rate for Payer: TriWest Medicare	$232.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$904.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$279.36

US Abdomen Limited

Facility

OP

$728.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$655.20
Rate for Payer: Aetna of AZ Commercial	$655.20
Rate for Payer: Aetna of AZ Medicare	$203.84
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$109.20
Rate for Payer: Amerigroup Medicare	$109.20
Rate for Payer: APIPA Medicare/Medicaid	$271.91
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$109.20
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$109.20
Rate for Payer: Bisbee Police All Plans	$189.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$495.04
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cash Price	$582.40
Rate for Payer: Cigna of AZ Commercial	$509.60
Rate for Payer: Copperpoint Commercial	$180.18
Rate for Payer: Health Net of AZ Commercial	$436.80
Rate for Payer: Health Net of AZ Medicare	$203.84
Rate for Payer: Humana of AZ Medicare	$109.20
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$582.40
Rate for Payer: TriWest Medicare	$109.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$424.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$131.04

US Abdomen Limited

Facility

IP

$728.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$189.28
Max. Negotiated Rate	$655.20
Rate for Payer: Aetna of AZ Commercial	$655.20
Rate for Payer: Bisbee Police All Plans	$189.28
Rate for Payer: Cash Price	$582.40
Rate for Payer: Self Pay Self Pay	$582.40

US Amniocentesis

Facility

OP

$778.00

Service Code	CPT 76946
Hospital Charge Code	10864721
Hospital Revenue Code	402
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Aetna of AZ Medicare	$217.84
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$116.70
Rate for Payer: Amerigroup Medicare	$116.70
Rate for Payer: APIPA Medicare/Medicaid	$290.58
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$116.70
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$116.70
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$529.04
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cigna of AZ Commercial	$544.60
Rate for Payer: Copperpoint Commercial	$192.56
Rate for Payer: Health Net of AZ Commercial	$466.80
Rate for Payer: Health Net of AZ Medicare	$217.84
Rate for Payer: Humana of AZ Medicare	$116.70
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$622.40
Rate for Payer: TriWest Medicare	$116.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$453.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$140.04

US Amniocentesis

Facility

IP

$778.00

Service Code	CPT 76946
Hospital Charge Code	10864721
Hospital Revenue Code	402
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Cash Price	$622.40
Rate for Payer: Self Pay Self Pay	$622.40

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