Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$4,208.40

Service Code	APR-DRG 1322
Hospital Charge Code	APRDRG1324
Min. Negotiated Rate	$4,208.40
Max. Negotiated Rate	$4,208.40
Rate for Payer: AHCCCS Medicaid	$4,208.40
Rate for Payer: Allwell Medicaid	$4,208.40
Rate for Payer: AZCH Complete Medicaid	$4,208.40
Rate for Payer: Banner UC Health Medicaid	$4,208.40
Rate for Payer: Mercy Care Medicaid	$4,208.40

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$3,174.54

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG1321
Min. Negotiated Rate	$3,174.54
Max. Negotiated Rate	$3,174.54
Rate for Payer: AHCCCS Medicaid	$3,174.54
Rate for Payer: Allwell Medicaid	$3,174.54
Rate for Payer: AZCH Complete Medicaid	$3,174.54
Rate for Payer: Banner UC Health Medicaid	$3,174.54
Rate for Payer: Mercy Care Medicaid	$3,174.54

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$12,227.51

Service Code	APR-DRG 1324
Hospital Charge Code	APRDRG1322
Min. Negotiated Rate	$12,227.51
Max. Negotiated Rate	$12,227.51
Rate for Payer: AHCCCS Medicaid	$12,227.51
Rate for Payer: Allwell Medicaid	$12,227.51
Rate for Payer: AZCH Complete Medicaid	$12,227.51
Rate for Payer: Banner UC Health Medicaid	$12,227.51
Rate for Payer: Mercy Care Medicaid	$12,227.51

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$12,227.51

Service Code	APR-DRG 1324
Hospital Charge Code	APRDRG1321
Min. Negotiated Rate	$12,227.51
Max. Negotiated Rate	$12,227.51
Rate for Payer: AHCCCS Medicaid	$12,227.51
Rate for Payer: Allwell Medicaid	$12,227.51
Rate for Payer: AZCH Complete Medicaid	$12,227.51
Rate for Payer: Banner UC Health Medicaid	$12,227.51
Rate for Payer: Mercy Care Medicaid	$12,227.51

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$7,028.73

Service Code	APR-DRG 1323
Hospital Charge Code	APRDRG1323
Min. Negotiated Rate	$7,028.73
Max. Negotiated Rate	$7,028.73
Rate for Payer: AHCCCS Medicaid	$7,028.73
Rate for Payer: Allwell Medicaid	$7,028.73
Rate for Payer: AZCH Complete Medicaid	$7,028.73
Rate for Payer: Banner UC Health Medicaid	$7,028.73
Rate for Payer: Mercy Care Medicaid	$7,028.73

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$3,174.54

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG1322
Min. Negotiated Rate	$3,174.54
Max. Negotiated Rate	$3,174.54
Rate for Payer: AHCCCS Medicaid	$3,174.54
Rate for Payer: Allwell Medicaid	$3,174.54
Rate for Payer: AZCH Complete Medicaid	$3,174.54
Rate for Payer: Banner UC Health Medicaid	$3,174.54
Rate for Payer: Mercy Care Medicaid	$3,174.54

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$4,208.40

Service Code	APR-DRG 1322
Hospital Charge Code	APRDRG1323
Min. Negotiated Rate	$4,208.40
Max. Negotiated Rate	$4,208.40
Rate for Payer: AHCCCS Medicaid	$4,208.40
Rate for Payer: Allwell Medicaid	$4,208.40
Rate for Payer: AZCH Complete Medicaid	$4,208.40
Rate for Payer: Banner UC Health Medicaid	$4,208.40
Rate for Payer: Mercy Care Medicaid	$4,208.40

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$3,174.54

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG1323
Min. Negotiated Rate	$3,174.54
Max. Negotiated Rate	$3,174.54
Rate for Payer: AHCCCS Medicaid	$3,174.54
Rate for Payer: Allwell Medicaid	$3,174.54
Rate for Payer: AZCH Complete Medicaid	$3,174.54
Rate for Payer: Banner UC Health Medicaid	$3,174.54
Rate for Payer: Mercy Care Medicaid	$3,174.54

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$4,208.40

Service Code	APR-DRG 1322
Hospital Charge Code	APRDRG1321
Min. Negotiated Rate	$4,208.40
Max. Negotiated Rate	$4,208.40
Rate for Payer: AHCCCS Medicaid	$4,208.40
Rate for Payer: Allwell Medicaid	$4,208.40
Rate for Payer: AZCH Complete Medicaid	$4,208.40
Rate for Payer: Banner UC Health Medicaid	$4,208.40
Rate for Payer: Mercy Care Medicaid	$4,208.40

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$12,227.51

Service Code	APR-DRG 1324
Hospital Charge Code	APRDRG1324
Min. Negotiated Rate	$12,227.51
Max. Negotiated Rate	$12,227.51
Rate for Payer: AHCCCS Medicaid	$12,227.51
Rate for Payer: Allwell Medicaid	$12,227.51
Rate for Payer: AZCH Complete Medicaid	$12,227.51
Rate for Payer: Banner UC Health Medicaid	$12,227.51
Rate for Payer: Mercy Care Medicaid	$12,227.51

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$12,227.51

Service Code	APR-DRG 1324
Hospital Charge Code	APRDRG1323
Min. Negotiated Rate	$12,227.51
Max. Negotiated Rate	$12,227.51
Rate for Payer: AHCCCS Medicaid	$12,227.51
Rate for Payer: Allwell Medicaid	$12,227.51
Rate for Payer: AZCH Complete Medicaid	$12,227.51
Rate for Payer: Banner UC Health Medicaid	$12,227.51
Rate for Payer: Mercy Care Medicaid	$12,227.51

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$7,028.73

Service Code	APR-DRG 1323
Hospital Charge Code	APRDRG1321
Min. Negotiated Rate	$7,028.73
Max. Negotiated Rate	$7,028.73
Rate for Payer: AHCCCS Medicaid	$7,028.73
Rate for Payer: Allwell Medicaid	$7,028.73
Rate for Payer: AZCH Complete Medicaid	$7,028.73
Rate for Payer: Banner UC Health Medicaid	$7,028.73
Rate for Payer: Mercy Care Medicaid	$7,028.73

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$3,174.54

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG1324
Min. Negotiated Rate	$3,174.54
Max. Negotiated Rate	$3,174.54
Rate for Payer: AHCCCS Medicaid	$3,174.54
Rate for Payer: Allwell Medicaid	$3,174.54
Rate for Payer: AZCH Complete Medicaid	$3,174.54
Rate for Payer: Banner UC Health Medicaid	$3,174.54
Rate for Payer: Mercy Care Medicaid	$3,174.54

Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period

Facility

IP

$7,028.73

Service Code	APR-DRG 1323
Hospital Charge Code	APRDRG1324
Min. Negotiated Rate	$7,028.73
Max. Negotiated Rate	$7,028.73
Rate for Payer: AHCCCS Medicaid	$7,028.73
Rate for Payer: Allwell Medicaid	$7,028.73
Rate for Payer: AZCH Complete Medicaid	$7,028.73
Rate for Payer: Banner UC Health Medicaid	$7,028.73
Rate for Payer: Mercy Care Medicaid	$7,028.73

B.pertussisB.parapertussis PCR LC

Facility

IP

$400.00

Service Code	CPT 87798
Hospital Charge Code	2087564
Hospital Revenue Code	301
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna of AZ Commercial	$360.00
Rate for Payer: Bisbee Police All Plans	$104.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Self Pay Self Pay	$320.00

B.pertussisB.parapertussis PCR LC

Facility

OP

$400.00

Service Code	CPT 87798
Hospital Charge Code	2087564
Hospital Revenue Code	301
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna of AZ Commercial	$360.00
Rate for Payer: Aetna of AZ Medicare	$112.00
Rate for Payer: Allwell Medicare	$64.00
Rate for Payer: Amerigroup Medicare	$64.00
Rate for Payer: APIPA Medicare/Medicaid	$149.40
Rate for Payer: AZCH Complete Medicare	$64.00
Rate for Payer: Banner UC Health Medicare	$64.00
Rate for Payer: Bisbee Police All Plans	$104.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$272.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cigna of AZ Commercial	$260.00
Rate for Payer: Copperpoint Commercial	$99.00
Rate for Payer: Health Net of AZ Commercial	$240.00
Rate for Payer: Health Net of AZ Medicare	$112.00
Rate for Payer: Humana of AZ Medicare	$64.00
Rate for Payer: Self Pay Self Pay	$320.00
Rate for Payer: TriWest Medicare	$64.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$233.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.00

B pertussis IgA Ab LC

Facility

OP

$247.00

Service Code	CPT 86615
Hospital Charge Code	22311176
Hospital Revenue Code	302
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Aetna of AZ Medicare	$69.16
Rate for Payer: Allwell Medicare	$39.52
Rate for Payer: Amerigroup Medicare	$39.52
Rate for Payer: APIPA Medicare/Medicaid	$92.25
Rate for Payer: AZCH Complete Medicare	$39.52
Rate for Payer: Banner UC Health Medicare	$39.52
Rate for Payer: Bisbee Police All Plans	$64.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$167.96
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cigna of AZ Commercial	$160.55
Rate for Payer: Copperpoint Commercial	$61.13
Rate for Payer: Health Net of AZ Commercial	$148.20
Rate for Payer: Health Net of AZ Medicare	$69.16
Rate for Payer: Humana of AZ Medicare	$39.52
Rate for Payer: Self Pay Self Pay	$197.60
Rate for Payer: TriWest Medicare	$39.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$144.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$44.46

B pertussis IgA Ab LC

Facility

IP

$247.00

Service Code	CPT 86615
Hospital Charge Code	22311176
Hospital Revenue Code	302
Min. Negotiated Rate	$64.22
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Bisbee Police All Plans	$64.22
Rate for Payer: Cash Price	$197.60
Rate for Payer: Self Pay Self Pay	$197.60

B pertussis IgG Ab LC

Facility

OP

$254.00

Service Code	CPT 86615
Hospital Charge Code	2087563
Hospital Revenue Code	302
Min. Negotiated Rate	$40.64
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Aetna of AZ Medicare	$71.12
Rate for Payer: Allwell Medicare	$40.64
Rate for Payer: Amerigroup Medicare	$40.64
Rate for Payer: APIPA Medicare/Medicaid	$94.87
Rate for Payer: AZCH Complete Medicare	$40.64
Rate for Payer: Banner UC Health Medicare	$40.64
Rate for Payer: Bisbee Police All Plans	$66.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$172.72
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cigna of AZ Commercial	$165.10
Rate for Payer: Copperpoint Commercial	$62.87
Rate for Payer: Health Net of AZ Commercial	$152.40
Rate for Payer: Health Net of AZ Medicare	$71.12
Rate for Payer: Humana of AZ Medicare	$40.64
Rate for Payer: Self Pay Self Pay	$203.20
Rate for Payer: TriWest Medicare	$40.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.72

B pertussis IgG Ab LC

Facility

IP

$254.00

Service Code	CPT 86615
Hospital Charge Code	2087563
Hospital Revenue Code	302
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$228.60
Rate for Payer: Aetna of AZ Commercial	$228.60
Rate for Payer: Bisbee Police All Plans	$66.04
Rate for Payer: Cash Price	$203.20
Rate for Payer: Self Pay Self Pay	$203.20

B pertussis IgG/IgM Ab LC

Facility

OP

$381.00

Service Code	CPT 87798
Hospital Charge Code	22201710
Hospital Revenue Code	301
Min. Negotiated Rate	$60.96
Max. Negotiated Rate	$342.90
Rate for Payer: Aetna of AZ Commercial	$342.90
Rate for Payer: Aetna of AZ Medicare	$106.68
Rate for Payer: Allwell Medicare	$60.96
Rate for Payer: Amerigroup Medicare	$60.96
Rate for Payer: APIPA Medicare/Medicaid	$142.30
Rate for Payer: AZCH Complete Medicare	$60.96
Rate for Payer: Banner UC Health Medicare	$60.96
Rate for Payer: Bisbee Police All Plans	$99.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$259.08
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cigna of AZ Commercial	$247.65
Rate for Payer: Copperpoint Commercial	$94.30
Rate for Payer: Health Net of AZ Commercial	$228.60
Rate for Payer: Health Net of AZ Medicare	$106.68
Rate for Payer: Humana of AZ Medicare	$60.96
Rate for Payer: Self Pay Self Pay	$304.80
Rate for Payer: TriWest Medicare	$60.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$222.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.58

B pertussis IgG/IgM Ab LC

Facility

IP

$381.00

Service Code	CPT 87798
Hospital Charge Code	22201710
Hospital Revenue Code	301
Min. Negotiated Rate	$99.06
Max. Negotiated Rate	$342.90
Rate for Payer: Aetna of AZ Commercial	$342.90
Rate for Payer: Bisbee Police All Plans	$99.06
Rate for Payer: Cash Price	$304.80
Rate for Payer: Self Pay Self Pay	$304.80

B pertussis IgM Ab LC

Facility

IP

$277.00

Service Code	CPT 86615
Hospital Charge Code	22311177
Hospital Revenue Code	302
Min. Negotiated Rate	$72.02
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna of AZ Commercial	$249.30
Rate for Payer: Bisbee Police All Plans	$72.02
Rate for Payer: Cash Price	$221.60
Rate for Payer: Self Pay Self Pay	$221.60

B pertussis IgM Ab LC

Facility

OP

$277.00

Service Code	CPT 86615
Hospital Charge Code	22311177
Hospital Revenue Code	302
Min. Negotiated Rate	$44.32
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna of AZ Commercial	$249.30
Rate for Payer: Aetna of AZ Medicare	$77.56
Rate for Payer: Allwell Medicare	$44.32
Rate for Payer: Amerigroup Medicare	$44.32
Rate for Payer: APIPA Medicare/Medicaid	$103.46
Rate for Payer: AZCH Complete Medicare	$44.32
Rate for Payer: Banner UC Health Medicare	$44.32
Rate for Payer: Bisbee Police All Plans	$72.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$188.36
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cigna of AZ Commercial	$180.05
Rate for Payer: Copperpoint Commercial	$68.56
Rate for Payer: Health Net of AZ Commercial	$166.20
Rate for Payer: Health Net of AZ Medicare	$77.56
Rate for Payer: Humana of AZ Medicare	$44.32
Rate for Payer: Self Pay Self Pay	$221.60
Rate for Payer: TriWest Medicare	$44.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$161.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$49.86

B Pertussis, Nasophar Culture

Facility

OP

$212.00

Service Code	CPT 87070
Hospital Charge Code	2269430
Hospital Revenue Code	300
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$190.80
Rate for Payer: Aetna of AZ Commercial	$190.80
Rate for Payer: Aetna of AZ Medicare	$59.36
Rate for Payer: Allwell Medicare	$33.92
Rate for Payer: Amerigroup Medicare	$33.92
Rate for Payer: APIPA Medicare/Medicaid	$79.18
Rate for Payer: AZCH Complete Medicare	$33.92
Rate for Payer: Banner UC Health Medicare	$33.92
Rate for Payer: Bisbee Police All Plans	$55.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.16
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cigna of AZ Commercial	$137.80
Rate for Payer: Copperpoint Commercial	$52.47
Rate for Payer: Health Net of AZ Commercial	$127.20
Rate for Payer: Health Net of AZ Medicare	$59.36
Rate for Payer: Humana of AZ Medicare	$33.92
Rate for Payer: Self Pay Self Pay	$169.60
Rate for Payer: TriWest Medicare	$33.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$123.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.16

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