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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

US UE Venous Duplex Right

Facility

IP

$862.00

Service Code	CPT 93971
Hospital Charge Code	823481
Hospital Revenue Code	921
Min. Negotiated Rate	$224.12
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Cash Price	$689.60
Rate for Payer: Self Pay Self Pay	$689.60

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$5,874.93

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG5193
Min. Negotiated Rate	$5,874.93
Max. Negotiated Rate	$5,874.93
Rate for Payer: AHCCCS Medicaid	$5,874.93
Rate for Payer: Allwell Medicaid	$5,874.93
Rate for Payer: AZCH Complete Medicaid	$5,874.93
Rate for Payer: Banner UC Health Medicaid	$5,874.93
Rate for Payer: Mercy Care Medicaid	$5,874.93

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$12,665.18

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG5191
Min. Negotiated Rate	$12,665.18
Max. Negotiated Rate	$12,665.18
Rate for Payer: AHCCCS Medicaid	$12,665.18
Rate for Payer: Allwell Medicaid	$12,665.18
Rate for Payer: AZCH Complete Medicaid	$12,665.18
Rate for Payer: Banner UC Health Medicaid	$12,665.18
Rate for Payer: Mercy Care Medicaid	$12,665.18

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$24,321.05

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG5194
Min. Negotiated Rate	$24,321.05
Max. Negotiated Rate	$24,321.05
Rate for Payer: AHCCCS Medicaid	$24,321.05
Rate for Payer: Allwell Medicaid	$24,321.05
Rate for Payer: AZCH Complete Medicaid	$24,321.05
Rate for Payer: Banner UC Health Medicaid	$24,321.05
Rate for Payer: Mercy Care Medicaid	$24,321.05

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$5,874.93

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG5191
Min. Negotiated Rate	$5,874.93
Max. Negotiated Rate	$5,874.93
Rate for Payer: AHCCCS Medicaid	$5,874.93
Rate for Payer: Allwell Medicaid	$5,874.93
Rate for Payer: AZCH Complete Medicaid	$5,874.93
Rate for Payer: Banner UC Health Medicaid	$5,874.93
Rate for Payer: Mercy Care Medicaid	$5,874.93

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$24,321.05

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG5193
Min. Negotiated Rate	$24,321.05
Max. Negotiated Rate	$24,321.05
Rate for Payer: AHCCCS Medicaid	$24,321.05
Rate for Payer: Allwell Medicaid	$24,321.05
Rate for Payer: AZCH Complete Medicaid	$24,321.05
Rate for Payer: Banner UC Health Medicaid	$24,321.05
Rate for Payer: Mercy Care Medicaid	$24,321.05

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$7,312.10

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG5194
Min. Negotiated Rate	$7,312.10
Max. Negotiated Rate	$7,312.10
Rate for Payer: AHCCCS Medicaid	$7,312.10
Rate for Payer: Allwell Medicaid	$7,312.10
Rate for Payer: AZCH Complete Medicaid	$7,312.10
Rate for Payer: Banner UC Health Medicaid	$7,312.10
Rate for Payer: Mercy Care Medicaid	$7,312.10

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$24,321.05

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG5192
Min. Negotiated Rate	$24,321.05
Max. Negotiated Rate	$24,321.05
Rate for Payer: AHCCCS Medicaid	$24,321.05
Rate for Payer: Allwell Medicaid	$24,321.05
Rate for Payer: AZCH Complete Medicaid	$24,321.05
Rate for Payer: Banner UC Health Medicaid	$24,321.05
Rate for Payer: Mercy Care Medicaid	$24,321.05

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$7,312.10

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG5192
Min. Negotiated Rate	$7,312.10
Max. Negotiated Rate	$7,312.10
Rate for Payer: AHCCCS Medicaid	$7,312.10
Rate for Payer: Allwell Medicaid	$7,312.10
Rate for Payer: AZCH Complete Medicaid	$7,312.10
Rate for Payer: Banner UC Health Medicaid	$7,312.10
Rate for Payer: Mercy Care Medicaid	$7,312.10

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$12,665.18

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG5193
Min. Negotiated Rate	$12,665.18
Max. Negotiated Rate	$12,665.18
Rate for Payer: AHCCCS Medicaid	$12,665.18
Rate for Payer: Allwell Medicaid	$12,665.18
Rate for Payer: AZCH Complete Medicaid	$12,665.18
Rate for Payer: Banner UC Health Medicaid	$12,665.18
Rate for Payer: Mercy Care Medicaid	$12,665.18

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$12,665.18

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG5192
Min. Negotiated Rate	$12,665.18
Max. Negotiated Rate	$12,665.18
Rate for Payer: AHCCCS Medicaid	$12,665.18
Rate for Payer: Allwell Medicaid	$12,665.18
Rate for Payer: AZCH Complete Medicaid	$12,665.18
Rate for Payer: Banner UC Health Medicaid	$12,665.18
Rate for Payer: Mercy Care Medicaid	$12,665.18

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$5,874.93

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG5192
Min. Negotiated Rate	$5,874.93
Max. Negotiated Rate	$5,874.93
Rate for Payer: AHCCCS Medicaid	$5,874.93
Rate for Payer: Allwell Medicaid	$5,874.93
Rate for Payer: AZCH Complete Medicaid	$5,874.93
Rate for Payer: Banner UC Health Medicaid	$5,874.93
Rate for Payer: Mercy Care Medicaid	$5,874.93

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$5,874.93

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG5194
Min. Negotiated Rate	$5,874.93
Max. Negotiated Rate	$5,874.93
Rate for Payer: AHCCCS Medicaid	$5,874.93
Rate for Payer: Allwell Medicaid	$5,874.93
Rate for Payer: AZCH Complete Medicaid	$5,874.93
Rate for Payer: Banner UC Health Medicaid	$5,874.93
Rate for Payer: Mercy Care Medicaid	$5,874.93

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$24,321.05

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG5191
Min. Negotiated Rate	$24,321.05
Max. Negotiated Rate	$24,321.05
Rate for Payer: AHCCCS Medicaid	$24,321.05
Rate for Payer: Allwell Medicaid	$24,321.05
Rate for Payer: AZCH Complete Medicaid	$24,321.05
Rate for Payer: Banner UC Health Medicaid	$24,321.05
Rate for Payer: Mercy Care Medicaid	$24,321.05

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$7,312.10

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG5193
Min. Negotiated Rate	$7,312.10
Max. Negotiated Rate	$7,312.10
Rate for Payer: AHCCCS Medicaid	$7,312.10
Rate for Payer: Allwell Medicaid	$7,312.10
Rate for Payer: AZCH Complete Medicaid	$7,312.10
Rate for Payer: Banner UC Health Medicaid	$7,312.10
Rate for Payer: Mercy Care Medicaid	$7,312.10

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$12,665.18

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG5194
Min. Negotiated Rate	$12,665.18
Max. Negotiated Rate	$12,665.18
Rate for Payer: AHCCCS Medicaid	$12,665.18
Rate for Payer: Allwell Medicaid	$12,665.18
Rate for Payer: AZCH Complete Medicaid	$12,665.18
Rate for Payer: Banner UC Health Medicaid	$12,665.18
Rate for Payer: Mercy Care Medicaid	$12,665.18

Uterine And Adnexa Procedures For Leiomyoma

Facility

IP

$7,312.10

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG5191
Min. Negotiated Rate	$7,312.10
Max. Negotiated Rate	$7,312.10
Rate for Payer: AHCCCS Medicaid	$7,312.10
Rate for Payer: Allwell Medicaid	$7,312.10
Rate for Payer: AZCH Complete Medicaid	$7,312.10
Rate for Payer: Banner UC Health Medicaid	$7,312.10
Rate for Payer: Mercy Care Medicaid	$7,312.10

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$6,013.80

Service Code	APR-DRG 5131
Hospital Charge Code	APRDRG5133
Min. Negotiated Rate	$6,013.80
Max. Negotiated Rate	$6,013.80
Rate for Payer: AHCCCS Medicaid	$6,013.80
Rate for Payer: Allwell Medicaid	$6,013.80
Rate for Payer: AZCH Complete Medicaid	$6,013.80
Rate for Payer: Banner UC Health Medicaid	$6,013.80
Rate for Payer: Mercy Care Medicaid	$6,013.80

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$22,557.02

Service Code	APR-DRG 5134
Hospital Charge Code	APRDRG5134
Min. Negotiated Rate	$22,557.02
Max. Negotiated Rate	$22,557.02
Rate for Payer: AHCCCS Medicaid	$22,557.02
Rate for Payer: Allwell Medicaid	$22,557.02
Rate for Payer: AZCH Complete Medicaid	$22,557.02
Rate for Payer: Banner UC Health Medicaid	$22,557.02
Rate for Payer: Mercy Care Medicaid	$22,557.02

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$7,156.38

Service Code	APR-DRG 5132
Hospital Charge Code	APRDRG5132
Min. Negotiated Rate	$7,156.38
Max. Negotiated Rate	$7,156.38
Rate for Payer: AHCCCS Medicaid	$7,156.38
Rate for Payer: Allwell Medicaid	$7,156.38
Rate for Payer: AZCH Complete Medicaid	$7,156.38
Rate for Payer: Banner UC Health Medicaid	$7,156.38
Rate for Payer: Mercy Care Medicaid	$7,156.38

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$6,013.80

Service Code	APR-DRG 5131
Hospital Charge Code	APRDRG5132
Min. Negotiated Rate	$6,013.80
Max. Negotiated Rate	$6,013.80
Rate for Payer: AHCCCS Medicaid	$6,013.80
Rate for Payer: Allwell Medicaid	$6,013.80
Rate for Payer: AZCH Complete Medicaid	$6,013.80
Rate for Payer: Banner UC Health Medicaid	$6,013.80
Rate for Payer: Mercy Care Medicaid	$6,013.80

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$12,243.64

Service Code	APR-DRG 5133
Hospital Charge Code	APRDRG5131
Min. Negotiated Rate	$12,243.64
Max. Negotiated Rate	$12,243.64
Rate for Payer: AHCCCS Medicaid	$12,243.64
Rate for Payer: Allwell Medicaid	$12,243.64
Rate for Payer: AZCH Complete Medicaid	$12,243.64
Rate for Payer: Banner UC Health Medicaid	$12,243.64
Rate for Payer: Mercy Care Medicaid	$12,243.64

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$22,557.02

Service Code	APR-DRG 5134
Hospital Charge Code	APRDRG5131
Min. Negotiated Rate	$22,557.02
Max. Negotiated Rate	$22,557.02
Rate for Payer: AHCCCS Medicaid	$22,557.02
Rate for Payer: Allwell Medicaid	$22,557.02
Rate for Payer: AZCH Complete Medicaid	$22,557.02
Rate for Payer: Banner UC Health Medicaid	$22,557.02
Rate for Payer: Mercy Care Medicaid	$22,557.02

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$7,156.38

Service Code	APR-DRG 5132
Hospital Charge Code	APRDRG5133
Min. Negotiated Rate	$7,156.38
Max. Negotiated Rate	$7,156.38
Rate for Payer: AHCCCS Medicaid	$7,156.38
Rate for Payer: Allwell Medicaid	$7,156.38
Rate for Payer: AZCH Complete Medicaid	$7,156.38
Rate for Payer: Banner UC Health Medicaid	$7,156.38
Rate for Payer: Mercy Care Medicaid	$7,156.38

Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma

Facility

IP

$12,243.64

Service Code	APR-DRG 5133
Hospital Charge Code	APRDRG5132
Min. Negotiated Rate	$12,243.64
Max. Negotiated Rate	$12,243.64
Rate for Payer: AHCCCS Medicaid	$12,243.64
Rate for Payer: Allwell Medicaid	$12,243.64
Rate for Payer: AZCH Complete Medicaid	$12,243.64
Rate for Payer: Banner UC Health Medicaid	$12,243.64
Rate for Payer: Mercy Care Medicaid	$12,243.64

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