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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DEFOGGER

Facility

OP

$11.00

Hospital Charge Code	22355325
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna of AZ Commercial	$9.90
Rate for Payer: Aetna of AZ Medicare	$3.08
Rate for Payer: Allwell Medicare	$1.65
Rate for Payer: Amerigroup Medicare	$1.65
Rate for Payer: APIPA Medicare/Medicaid	$4.11
Rate for Payer: AZCH Complete Medicare	$1.65
Rate for Payer: Banner UC Health Medicare	$1.65
Rate for Payer: Bisbee Police All Plans	$2.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.48
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cigna of AZ Commercial	$7.70
Rate for Payer: Copperpoint Commercial	$2.72
Rate for Payer: Health Net of AZ Commercial	$6.60
Rate for Payer: Health Net of AZ Medicare	$3.08
Rate for Payer: Humana of AZ Medicare	$1.65
Rate for Payer: Self Pay Self Pay	$8.80
Rate for Payer: TriWest Medicare	$1.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.98

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$4,510.70

Service Code	APR-DRG 0421
Hospital Charge Code	APRDRG0424
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$5,412.00

Service Code	APR-DRG 0422
Hospital Charge Code	APRDRG0421
Min. Negotiated Rate	$5,412.00
Max. Negotiated Rate	$5,412.00
Rate for Payer: AHCCCS Medicaid	$5,412.00
Rate for Payer: Allwell Medicaid	$5,412.00
Rate for Payer: AZCH Complete Medicaid	$5,412.00
Rate for Payer: Banner UC Health Medicaid	$5,412.00
Rate for Payer: Mercy Care Medicaid	$5,412.00

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0424
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$5,412.00

Service Code	APR-DRG 0422
Hospital Charge Code	APRDRG0422
Min. Negotiated Rate	$5,412.00
Max. Negotiated Rate	$5,412.00
Rate for Payer: AHCCCS Medicaid	$5,412.00
Rate for Payer: Allwell Medicaid	$5,412.00
Rate for Payer: AZCH Complete Medicaid	$5,412.00
Rate for Payer: Banner UC Health Medicaid	$5,412.00
Rate for Payer: Mercy Care Medicaid	$5,412.00

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$4,510.70

Service Code	APR-DRG 0421
Hospital Charge Code	APRDRG0423
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$4,510.70

Service Code	APR-DRG 0421
Hospital Charge Code	APRDRG0422
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0422
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$5,412.00

Service Code	APR-DRG 0422
Hospital Charge Code	APRDRG0423
Min. Negotiated Rate	$5,412.00
Max. Negotiated Rate	$5,412.00
Rate for Payer: AHCCCS Medicaid	$5,412.00
Rate for Payer: Allwell Medicaid	$5,412.00
Rate for Payer: AZCH Complete Medicaid	$5,412.00
Rate for Payer: Banner UC Health Medicaid	$5,412.00
Rate for Payer: Mercy Care Medicaid	$5,412.00

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$17,275.48

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG0421
Min. Negotiated Rate	$17,275.48
Max. Negotiated Rate	$17,275.48
Rate for Payer: AHCCCS Medicaid	$17,275.48
Rate for Payer: Allwell Medicaid	$17,275.48
Rate for Payer: AZCH Complete Medicaid	$17,275.48
Rate for Payer: Banner UC Health Medicaid	$17,275.48
Rate for Payer: Mercy Care Medicaid	$17,275.48

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0423
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$4,510.70

Service Code	APR-DRG 0421
Hospital Charge Code	APRDRG0421
Min. Negotiated Rate	$4,510.70
Max. Negotiated Rate	$4,510.70
Rate for Payer: AHCCCS Medicaid	$4,510.70
Rate for Payer: Allwell Medicaid	$4,510.70
Rate for Payer: AZCH Complete Medicaid	$4,510.70
Rate for Payer: Banner UC Health Medicaid	$4,510.70
Rate for Payer: Mercy Care Medicaid	$4,510.70

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$8,202.87

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG0421
Min. Negotiated Rate	$8,202.87
Max. Negotiated Rate	$8,202.87
Rate for Payer: AHCCCS Medicaid	$8,202.87
Rate for Payer: Allwell Medicaid	$8,202.87
Rate for Payer: AZCH Complete Medicaid	$8,202.87
Rate for Payer: Banner UC Health Medicaid	$8,202.87
Rate for Payer: Mercy Care Medicaid	$8,202.87

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$17,275.48

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG0423
Min. Negotiated Rate	$17,275.48
Max. Negotiated Rate	$17,275.48
Rate for Payer: AHCCCS Medicaid	$17,275.48
Rate for Payer: Allwell Medicaid	$17,275.48
Rate for Payer: AZCH Complete Medicaid	$17,275.48
Rate for Payer: Banner UC Health Medicaid	$17,275.48
Rate for Payer: Mercy Care Medicaid	$17,275.48

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$17,275.48

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG0424
Min. Negotiated Rate	$17,275.48
Max. Negotiated Rate	$17,275.48
Rate for Payer: AHCCCS Medicaid	$17,275.48
Rate for Payer: Allwell Medicaid	$17,275.48
Rate for Payer: AZCH Complete Medicaid	$17,275.48
Rate for Payer: Banner UC Health Medicaid	$17,275.48
Rate for Payer: Mercy Care Medicaid	$17,275.48

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$17,275.48

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG0422
Min. Negotiated Rate	$17,275.48
Max. Negotiated Rate	$17,275.48
Rate for Payer: AHCCCS Medicaid	$17,275.48
Rate for Payer: Allwell Medicaid	$17,275.48
Rate for Payer: AZCH Complete Medicaid	$17,275.48
Rate for Payer: Banner UC Health Medicaid	$17,275.48
Rate for Payer: Mercy Care Medicaid	$17,275.48

Degenerative Nervous System Disorders Except Multiple Sclerosis

Facility

IP

$5,412.00

Service Code	APR-DRG 0422
Hospital Charge Code	APRDRG0424
Min. Negotiated Rate	$5,412.00
Max. Negotiated Rate	$5,412.00
Rate for Payer: AHCCCS Medicaid	$5,412.00
Rate for Payer: Allwell Medicaid	$5,412.00
Rate for Payer: AZCH Complete Medicaid	$5,412.00
Rate for Payer: Banner UC Health Medicaid	$5,412.00
Rate for Payer: Mercy Care Medicaid	$5,412.00

Dehydroepiandrosterone (DHEA) LC

Facility

IP

$838.00

Service Code	CPT 82626
Hospital Charge Code	1906831
Hospital Revenue Code	301
Min. Negotiated Rate	$217.88
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Bisbee Police All Plans	$217.88
Rate for Payer: Cash Price	$670.40
Rate for Payer: Self Pay Self Pay	$670.40

Dehydroepiandrosterone (DHEA) LC

Facility

OP

$838.00

Service Code	CPT 82626
Hospital Charge Code	1906831
Hospital Revenue Code	301
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$754.20
Rate for Payer: Aetna of AZ Commercial	$754.20
Rate for Payer: Aetna of AZ Medicare	$234.64
Rate for Payer: AHCCCS Medicaid	$25.27
Rate for Payer: Allwell Medicaid	$25.27
Rate for Payer: Allwell Medicare	$125.70
Rate for Payer: Amerigroup Medicare	$125.70
Rate for Payer: APIPA Medicare/Medicaid	$312.99
Rate for Payer: AZCH Complete Medicaid	$25.27
Rate for Payer: AZCH Complete Medicare	$125.70
Rate for Payer: Banner UC Health Medicaid	$25.27
Rate for Payer: Banner UC Health Medicare	$125.70
Rate for Payer: Bisbee Police All Plans	$217.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$569.84
Rate for Payer: Cash Price	$670.40
Rate for Payer: Cash Price	$670.40
Rate for Payer: Cigna of AZ Commercial	$544.70
Rate for Payer: Copperpoint Commercial	$207.40
Rate for Payer: Health Net of AZ Commercial	$502.80
Rate for Payer: Health Net of AZ Medicare	$234.64
Rate for Payer: Humana of AZ Medicare	$125.70
Rate for Payer: Mercy Care Medicaid	$25.27
Rate for Payer: Self Pay Self Pay	$670.40
Rate for Payer: TriWest Medicare	$125.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$488.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$150.84

Dehydroepiandrosterone Sulfate LC

Facility

IP

$483.00

Service Code	CPT 82627
Hospital Charge Code	1906835
Hospital Revenue Code	301
Min. Negotiated Rate	$125.58
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Cash Price	$386.40
Rate for Payer: Self Pay Self Pay	$386.40

Dehydroepiandrosterone Sulfate LC

Facility

OP

$483.00

Service Code	CPT 82627
Hospital Charge Code	1906835
Hospital Revenue Code	301
Min. Negotiated Rate	$22.23
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Aetna of AZ Medicare	$135.24
Rate for Payer: AHCCCS Medicaid	$22.23
Rate for Payer: Allwell Medicaid	$22.23
Rate for Payer: Allwell Medicare	$72.45
Rate for Payer: Amerigroup Medicare	$72.45
Rate for Payer: APIPA Medicare/Medicaid	$180.40
Rate for Payer: AZCH Complete Medicaid	$22.23
Rate for Payer: AZCH Complete Medicare	$72.45
Rate for Payer: Banner UC Health Medicaid	$22.23
Rate for Payer: Banner UC Health Medicare	$72.45
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$328.44
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$313.95
Rate for Payer: Copperpoint Commercial	$119.54
Rate for Payer: Health Net of AZ Commercial	$289.80
Rate for Payer: Health Net of AZ Medicare	$135.24
Rate for Payer: Humana of AZ Medicare	$72.45
Rate for Payer: Mercy Care Medicaid	$22.23
Rate for Payer: Self Pay Self Pay	$386.40
Rate for Payer: TriWest Medicare	$72.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.94

denosumab 60 mg/mL Sol[CQCH]

Facility

OP

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Aetna of AZ Medicare	$389.51
Rate for Payer: AHCCCS Medicaid	$36.90
Rate for Payer: Allwell Medicaid	$36.90
Rate for Payer: Allwell Medicare	$208.67
Rate for Payer: Amerigroup Medicare	$208.67
Rate for Payer: APIPA Medicare/Medicaid	$519.58
Rate for Payer: AZCH Complete Medicaid	$36.90
Rate for Payer: AZCH Complete Medicare	$208.67
Rate for Payer: Banner UC Health Medicaid	$36.90
Rate for Payer: Banner UC Health Medicare	$208.67
Rate for Payer: Bisbee Police All Plans	$361.69
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$945.96
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Cigna of AZ Commercial	$904.23
Rate for Payer: Copperpoint Commercial	$344.30
Rate for Payer: Health Net of AZ Commercial	$834.67
Rate for Payer: Health Net of AZ Medicare	$389.51
Rate for Payer: Humana of AZ Medicare	$208.67
Rate for Payer: Mercy Care Medicaid	$36.90
Rate for Payer: Self Pay Self Pay	$1,112.90
Rate for Payer: TriWest Medicare	$208.67
Rate for Payer: UnitedHealth Group of AZ Commercial	$811.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$250.40

denosumab 60 mg/mL Sol[CQCH]

Facility

IP

$1,391.12

Service Code	HCPCS J0897
Hospital Charge Code	187942023
Hospital Revenue Code	250
Min. Negotiated Rate	$361.69
Max. Negotiated Rate	$1,252.01
Rate for Payer: Aetna of AZ Commercial	$1,252.01
Rate for Payer: Bisbee Police All Plans	$361.69
Rate for Payer: Cash Price	$1,112.90
Rate for Payer: Self Pay Self Pay	$1,112.90

Dental Diseases And Disorders

Facility

IP

$15,899.34

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$15,899.34
Max. Negotiated Rate	$15,899.34
Rate for Payer: AHCCCS Medicaid	$15,899.34
Rate for Payer: Allwell Medicaid	$15,899.34
Rate for Payer: AZCH Complete Medicaid	$15,899.34
Rate for Payer: Banner UC Health Medicaid	$15,899.34
Rate for Payer: Mercy Care Medicaid	$15,899.34

Dental Diseases And Disorders

Facility

IP

$3,871.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG1141
Min. Negotiated Rate	$3,871.73
Max. Negotiated Rate	$3,871.73
Rate for Payer: AHCCCS Medicaid	$3,871.73
Rate for Payer: Allwell Medicaid	$3,871.73
Rate for Payer: AZCH Complete Medicaid	$3,871.73
Rate for Payer: Banner UC Health Medicaid	$3,871.73
Rate for Payer: Mercy Care Medicaid	$3,871.73

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