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

$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

$3,523.83

Service Code	APR-DRG 4651
Hospital Charge Code	APRDRG4651
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

$12,378.31

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG4652
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

$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

Urine Culture

Facility

IP

$164.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Cash Price	$131.20
Rate for Payer: Self Pay Self Pay	$131.20

Urine Culture

Facility

OP

$164.00

Service Code	CPT 87086
Hospital Charge Code	850756
Hospital Revenue Code	306
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Aetna of AZ Medicare	$45.92
Rate for Payer: Allwell Medicare	$26.24
Rate for Payer: Amerigroup Medicare	$26.24
Rate for Payer: APIPA Medicare/Medicaid	$61.25
Rate for Payer: AZCH Complete Medicare	$26.24
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$111.52
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$106.60
Rate for Payer: Copperpoint Commercial	$40.59
Rate for Payer: Health Net of AZ Commercial	$98.40
Rate for Payer: Health Net of AZ Medicare	$45.92
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Self Pay Self Pay	$131.20
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.52

Urine Drug Screen Standard

Facility

OP

$735.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Aetna of AZ Medicare	$205.80
Rate for Payer: Allwell Medicare	$117.60
Rate for Payer: Amerigroup Medicare	$117.60
Rate for Payer: APIPA Medicare/Medicaid	$274.52
Rate for Payer: AZCH Complete Medicare	$117.60
Rate for Payer: Banner UC Health Medicare	$117.60
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$499.80
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cigna of AZ Commercial	$477.75
Rate for Payer: Copperpoint Commercial	$181.91
Rate for Payer: Health Net of AZ Commercial	$441.00
Rate for Payer: Health Net of AZ Medicare	$205.80
Rate for Payer: Humana of AZ Medicare	$117.60
Rate for Payer: Self Pay Self Pay	$588.00
Rate for Payer: TriWest Medicare	$117.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$428.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$132.30

Urine Drug Screen Standard

Facility

IP

$735.00

Service Code	CPT 80307
Hospital Charge Code	22141048
Hospital Revenue Code	301
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Cash Price	$588.00
Rate for Payer: Self Pay Self Pay	$588.00

Urine Pregnancy Test POC

Facility

OP

$159.00

Service Code	CPT 81025 QW
Hospital Charge Code	607621
Hospital Revenue Code	300
Min. Negotiated Rate	$25.44
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	$25.44
Rate for Payer: Amerigroup Medicare	$25.44
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
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	$25.44
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$25.44
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

OP

$47.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Urine Volume

Facility

IP

$47.00

Service Code	CPT 81050
Hospital Charge Code	1137707
Hospital Revenue Code	301
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

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

Uroflowmetry- Complex

Facility

OP

$79.00

Service Code	CPT 51741
Hospital Charge Code	27291783
Hospital Revenue Code	360
Min. Negotiated Rate	$12.64
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	$101.17
Rate for Payer: Allwell Medicaid	$101.17
Rate for Payer: Allwell Medicare	$12.64
Rate for Payer: Amerigroup Medicare	$12.64
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicaid	$101.17
Rate for Payer: AZCH Complete Medicare	$12.64
Rate for Payer: Banner UC Health Medicaid	$101.17
Rate for Payer: Banner UC Health Medicare	$12.64
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	$12.64
Rate for Payer: Mercy Care Medicaid	$101.17
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

US Abdomen Complete

Facility

IP

$1,472.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$382.72
Max. Negotiated Rate	$1,324.80
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Bisbee Police All Plans	$382.72
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Self Pay Self Pay	$1,177.60

US Abdomen Complete

Facility

OP

$1,472.00

Service Code	CPT 76700
Hospital Charge Code	823404
Hospital Revenue Code	402
Min. Negotiated Rate	$235.52
Max. Negotiated Rate	$1,324.80
Rate for Payer: Aetna of AZ Commercial	$1,324.80
Rate for Payer: Aetna of AZ Medicare	$412.16
Rate for Payer: Allwell Medicare	$235.52
Rate for Payer: Amerigroup Medicare	$235.52
Rate for Payer: APIPA Medicare/Medicaid	$549.79
Rate for Payer: AZCH Complete Medicare	$235.52
Rate for Payer: Banner UC Health Medicare	$235.52
Rate for Payer: Bisbee Police All Plans	$382.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,000.96
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cigna of AZ Commercial	$1,030.40
Rate for Payer: Copperpoint Commercial	$364.32
Rate for Payer: Health Net of AZ Commercial	$883.20
Rate for Payer: Health Net of AZ Medicare	$412.16
Rate for Payer: Humana of AZ Medicare	$235.52
Rate for Payer: Self Pay Self Pay	$1,177.60
Rate for Payer: TriWest Medicare	$235.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$858.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$264.96

US Abdomen Limited

Facility

IP

$692.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$179.92
Max. Negotiated Rate	$622.80
Rate for Payer: Aetna of AZ Commercial	$622.80
Rate for Payer: Bisbee Police All Plans	$179.92
Rate for Payer: Cash Price	$553.60
Rate for Payer: Self Pay Self Pay	$553.60

US Abdomen Limited

Facility

OP

$692.00

Service Code	CPT 76705
Hospital Charge Code	823406
Hospital Revenue Code	402
Min. Negotiated Rate	$110.72
Max. Negotiated Rate	$622.80
Rate for Payer: Aetna of AZ Commercial	$622.80
Rate for Payer: Aetna of AZ Medicare	$193.76
Rate for Payer: Allwell Medicare	$110.72
Rate for Payer: Amerigroup Medicare	$110.72
Rate for Payer: APIPA Medicare/Medicaid	$258.46
Rate for Payer: AZCH Complete Medicare	$110.72
Rate for Payer: Banner UC Health Medicare	$110.72
Rate for Payer: Bisbee Police All Plans	$179.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$470.56
Rate for Payer: Cash Price	$553.60
Rate for Payer: Cigna of AZ Commercial	$484.40
Rate for Payer: Copperpoint Commercial	$171.27
Rate for Payer: Health Net of AZ Commercial	$415.20
Rate for Payer: Health Net of AZ Medicare	$193.76
Rate for Payer: Humana of AZ Medicare	$110.72
Rate for Payer: Self Pay Self Pay	$553.60
Rate for Payer: TriWest Medicare	$110.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$403.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$124.56

US Amniocentesis

Facility

OP

$778.00

Service Code	CPT 76946
Hospital Charge Code	10864721
Hospital Revenue Code	402
Min. Negotiated Rate	$124.48
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: Allwell Medicare	$124.48
Rate for Payer: Amerigroup Medicare	$124.48
Rate for Payer: APIPA Medicare/Medicaid	$290.58
Rate for Payer: AZCH Complete Medicare	$124.48
Rate for Payer: Banner UC Health Medicare	$124.48
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: 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	$124.48
Rate for Payer: Self Pay Self Pay	$622.40
Rate for Payer: TriWest Medicare	$124.48
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

US Aorta Duplex Complete

Facility

OP

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$132.48
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Aetna of AZ Medicare	$231.84
Rate for Payer: Allwell Medicare	$132.48
Rate for Payer: Amerigroup Medicare	$132.48
Rate for Payer: APIPA Medicare/Medicaid	$309.26
Rate for Payer: AZCH Complete Medicare	$132.48
Rate for Payer: Banner UC Health Medicare	$132.48
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$563.04
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cigna of AZ Commercial	$579.60
Rate for Payer: Copperpoint Commercial	$204.93
Rate for Payer: Health Net of AZ Commercial	$496.80
Rate for Payer: Health Net of AZ Medicare	$231.84
Rate for Payer: Humana of AZ Medicare	$132.48
Rate for Payer: Self Pay Self Pay	$662.40
Rate for Payer: TriWest Medicare	$132.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$482.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.04

US Aorta Duplex Complete

Facility

IP

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$215.28
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Cash Price	$662.40
Rate for Payer: Self Pay Self Pay	$662.40

US Aspiration Guidance

Facility

OP

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$143.20
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Aetna of AZ Medicare	$250.60
Rate for Payer: Allwell Medicare	$143.20
Rate for Payer: Amerigroup Medicare	$143.20
Rate for Payer: APIPA Medicare/Medicaid	$334.28
Rate for Payer: AZCH Complete Medicare	$143.20
Rate for Payer: Banner UC Health Medicare	$143.20
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$608.60
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cigna of AZ Commercial	$626.50
Rate for Payer: Copperpoint Commercial	$221.51
Rate for Payer: Health Net of AZ Commercial	$537.00
Rate for Payer: Health Net of AZ Medicare	$250.60
Rate for Payer: Humana of AZ Medicare	$143.20
Rate for Payer: Self Pay Self Pay	$716.00
Rate for Payer: TriWest Medicare	$143.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$521.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.10

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