Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Depression Except Major Depressive Disorder

Facility

IP

$2,042.48

Service Code	APR-DRG 7541
Hospital Charge Code	APRDRG7542
Min. Negotiated Rate	$2,042.48
Max. Negotiated Rate	$2,042.48
Rate for Payer: AHCCCS Medicaid	$2,042.48
Rate for Payer: Allwell Medicaid	$2,042.48
Rate for Payer: AZCH Complete Medicaid	$2,042.48
Rate for Payer: Banner UC Health Medicaid	$2,042.48
Rate for Payer: Mercy Care Medicaid	$2,042.48

Depression Except Major Depressive Disorder

Facility

IP

$2,837.16

Service Code	APR-DRG 7542
Hospital Charge Code	APRDRG7541
Min. Negotiated Rate	$2,837.16
Max. Negotiated Rate	$2,837.16
Rate for Payer: AHCCCS Medicaid	$2,837.16
Rate for Payer: Allwell Medicaid	$2,837.16
Rate for Payer: AZCH Complete Medicaid	$2,837.16
Rate for Payer: Banner UC Health Medicaid	$2,837.16
Rate for Payer: Mercy Care Medicaid	$2,837.16

Depression Except Major Depressive Disorder

Facility

IP

$10,887.13

Service Code	APR-DRG 7544
Hospital Charge Code	APRDRG7542
Min. Negotiated Rate	$10,887.13
Max. Negotiated Rate	$10,887.13
Rate for Payer: AHCCCS Medicaid	$10,887.13
Rate for Payer: Allwell Medicaid	$10,887.13
Rate for Payer: AZCH Complete Medicaid	$10,887.13
Rate for Payer: Banner UC Health Medicaid	$10,887.13
Rate for Payer: Mercy Care Medicaid	$10,887.13

Depression Except Major Depressive Disorder

Facility

IP

$4,831.94

Service Code	APR-DRG 7543
Hospital Charge Code	APRDRG7542
Min. Negotiated Rate	$4,831.94
Max. Negotiated Rate	$4,831.94
Rate for Payer: AHCCCS Medicaid	$4,831.94
Rate for Payer: Allwell Medicaid	$4,831.94
Rate for Payer: AZCH Complete Medicaid	$4,831.94
Rate for Payer: Banner UC Health Medicaid	$4,831.94
Rate for Payer: Mercy Care Medicaid	$4,831.94

Depression Except Major Depressive Disorder

Facility

IP

$4,831.94

Service Code	APR-DRG 7543
Hospital Charge Code	APRDRG7543
Min. Negotiated Rate	$4,831.94
Max. Negotiated Rate	$4,831.94
Rate for Payer: AHCCCS Medicaid	$4,831.94
Rate for Payer: Allwell Medicaid	$4,831.94
Rate for Payer: AZCH Complete Medicaid	$4,831.94
Rate for Payer: Banner UC Health Medicaid	$4,831.94
Rate for Payer: Mercy Care Medicaid	$4,831.94

Depression Except Major Depressive Disorder

Facility

IP

$10,887.13

Service Code	APR-DRG 7544
Hospital Charge Code	APRDRG7541
Min. Negotiated Rate	$10,887.13
Max. Negotiated Rate	$10,887.13
Rate for Payer: AHCCCS Medicaid	$10,887.13
Rate for Payer: Allwell Medicaid	$10,887.13
Rate for Payer: AZCH Complete Medicaid	$10,887.13
Rate for Payer: Banner UC Health Medicaid	$10,887.13
Rate for Payer: Mercy Care Medicaid	$10,887.13

Depression Except Major Depressive Disorder

Facility

IP

$2,837.16

Service Code	APR-DRG 7542
Hospital Charge Code	APRDRG7544
Min. Negotiated Rate	$2,837.16
Max. Negotiated Rate	$2,837.16
Rate for Payer: AHCCCS Medicaid	$2,837.16
Rate for Payer: Allwell Medicaid	$2,837.16
Rate for Payer: AZCH Complete Medicaid	$2,837.16
Rate for Payer: Banner UC Health Medicaid	$2,837.16
Rate for Payer: Mercy Care Medicaid	$2,837.16

Depression Except Major Depressive Disorder

Facility

IP

$4,831.94

Service Code	APR-DRG 7543
Hospital Charge Code	APRDRG7541
Min. Negotiated Rate	$4,831.94
Max. Negotiated Rate	$4,831.94
Rate for Payer: AHCCCS Medicaid	$4,831.94
Rate for Payer: Allwell Medicaid	$4,831.94
Rate for Payer: AZCH Complete Medicaid	$4,831.94
Rate for Payer: Banner UC Health Medicaid	$4,831.94
Rate for Payer: Mercy Care Medicaid	$4,831.94

Depression Except Major Depressive Disorder

Facility

IP

$10,887.13

Service Code	APR-DRG 7544
Hospital Charge Code	APRDRG7543
Min. Negotiated Rate	$10,887.13
Max. Negotiated Rate	$10,887.13
Rate for Payer: AHCCCS Medicaid	$10,887.13
Rate for Payer: Allwell Medicaid	$10,887.13
Rate for Payer: AZCH Complete Medicaid	$10,887.13
Rate for Payer: Banner UC Health Medicaid	$10,887.13
Rate for Payer: Mercy Care Medicaid	$10,887.13

DERMABOND PROPEN

Facility

IP

$105.00

Hospital Charge Code	22355194
Hospital Revenue Code	270
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Bisbee Police All Plans	$27.30
Rate for Payer: Cash Price	$84.00
Rate for Payer: Self Pay Self Pay	$84.00

DERMABOND PROPEN

Facility

OP

$105.00

Hospital Charge Code	22355194
Hospital Revenue Code	270
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of AZ Commercial	$94.50
Rate for Payer: Aetna of AZ Medicare	$29.40
Rate for Payer: Allwell Medicare	$15.75
Rate for Payer: Amerigroup Medicare	$15.75
Rate for Payer: APIPA Medicare/Medicaid	$39.22
Rate for Payer: AZCH Complete Medicare	$15.75
Rate for Payer: Banner UC Health Medicare	$15.75
Rate for Payer: Bisbee Police All Plans	$27.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$71.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cigna of AZ Commercial	$73.50
Rate for Payer: Copperpoint Commercial	$25.99
Rate for Payer: Health Net of AZ Commercial	$63.00
Rate for Payer: Health Net of AZ Medicare	$29.40
Rate for Payer: Humana of AZ Medicare	$15.75
Rate for Payer: Self Pay Self Pay	$84.00
Rate for Payer: TriWest Medicare	$15.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.90

DERMAGRAFT

Facility

IP

$235.00

Service Code	CPT Q4106
Hospital Charge Code	24358082
Hospital Revenue Code	636
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna of AZ Commercial	$211.50
Rate for Payer: Bisbee Police All Plans	$61.10
Rate for Payer: Cash Price	$188.00
Rate for Payer: Self Pay Self Pay	$188.00

DERMAGRAFT

Facility

OP

$235.00

Service Code	CPT Q4106
Hospital Charge Code	24358082
Hospital Revenue Code	636
Min. Negotiated Rate	$30.88
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna of AZ Commercial	$211.50
Rate for Payer: Aetna of AZ Medicare	$65.80
Rate for Payer: AHCCCS Medicaid	$30.88
Rate for Payer: Allwell Medicaid	$30.88
Rate for Payer: Allwell Medicare	$35.25
Rate for Payer: Amerigroup Medicare	$35.25
Rate for Payer: APIPA Medicare/Medicaid	$87.77
Rate for Payer: AZCH Complete Medicaid	$30.88
Rate for Payer: AZCH Complete Medicare	$35.25
Rate for Payer: Banner UC Health Medicaid	$30.88
Rate for Payer: Banner UC Health Medicare	$35.25
Rate for Payer: Bisbee Police All Plans	$61.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$159.80
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cigna of AZ Commercial	$164.50
Rate for Payer: Copperpoint Commercial	$58.16
Rate for Payer: Health Net of AZ Commercial	$141.00
Rate for Payer: Health Net of AZ Medicare	$65.80
Rate for Payer: Humana of AZ Medicare	$35.25
Rate for Payer: Mercy Care Medicaid	$30.88
Rate for Payer: Self Pay Self Pay	$188.00
Rate for Payer: TriWest Medicare	$35.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$137.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.30

DERMAGRAFT, PER SQUARE CENTIMETER

Facility

OP

$170.00

Service Code	CPT Q4106
Hospital Charge Code	24049286
Hospital Revenue Code	636
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Aetna of AZ Medicare	$47.60
Rate for Payer: AHCCCS Medicaid	$30.88
Rate for Payer: Allwell Medicaid	$30.88
Rate for Payer: Allwell Medicare	$25.50
Rate for Payer: Amerigroup Medicare	$25.50
Rate for Payer: APIPA Medicare/Medicaid	$63.50
Rate for Payer: AZCH Complete Medicaid	$30.88
Rate for Payer: AZCH Complete Medicare	$25.50
Rate for Payer: Banner UC Health Medicaid	$30.88
Rate for Payer: Banner UC Health Medicare	$25.50
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$115.60
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cigna of AZ Commercial	$119.00
Rate for Payer: Copperpoint Commercial	$42.08
Rate for Payer: Health Net of AZ Commercial	$102.00
Rate for Payer: Health Net of AZ Medicare	$47.60
Rate for Payer: Humana of AZ Medicare	$25.50
Rate for Payer: Mercy Care Medicaid	$30.88
Rate for Payer: Self Pay Self Pay	$136.00
Rate for Payer: TriWest Medicare	$25.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$99.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.60

DERMAGRAFT, PER SQUARE CENTIMETER

Facility

IP

$170.00

Service Code	CPT Q4106
Hospital Charge Code	24049286
Hospital Revenue Code	636
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Cash Price	$136.00
Rate for Payer: Self Pay Self Pay	$136.00

DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERV

Facility

OP

$318.00

Service Code	CPT 64632
Hospital Charge Code	24049523
Hospital Revenue Code	360
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Aetna of AZ Medicare	$89.04
Rate for Payer: AHCCCS Medicaid	$378.70
Rate for Payer: Allwell Medicaid	$378.70
Rate for Payer: Allwell Medicare	$47.70
Rate for Payer: Amerigroup Medicare	$47.70
Rate for Payer: APIPA Medicare/Medicaid	$118.77
Rate for Payer: AZCH Complete Medicaid	$378.70
Rate for Payer: AZCH Complete Medicare	$47.70
Rate for Payer: Banner UC Health Medicaid	$378.70
Rate for Payer: Banner UC Health Medicare	$47.70
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.24
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cigna of AZ Commercial	$159.00
Rate for Payer: Copperpoint Commercial	$78.70
Rate for Payer: Health Net of AZ Commercial	$190.80
Rate for Payer: Health Net of AZ Medicare	$89.04
Rate for Payer: Humana of AZ Medicare	$47.70
Rate for Payer: Mercy Care Medicaid	$378.70
Rate for Payer: Self Pay Self Pay	$254.40
Rate for Payer: TriWest Medicare	$47.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.24

DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERV

Facility

IP

$318.00

Service Code	CPT 64632
Hospital Charge Code	24049523
Hospital Revenue Code	360
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Cash Price	$254.40
Rate for Payer: Self Pay Self Pay	$254.40

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

OP

$334.00

Service Code	CPT 17110
Hospital Charge Code	24049519
Hospital Revenue Code	360
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Medicare	$93.52
Rate for Payer: AHCCCS Medicaid	$260.34
Rate for Payer: Allwell Medicaid	$260.34
Rate for Payer: Allwell Medicare	$50.10
Rate for Payer: Amerigroup Medicare	$50.10
Rate for Payer: APIPA Medicare/Medicaid	$124.75
Rate for Payer: AZCH Complete Medicaid	$260.34
Rate for Payer: AZCH Complete Medicare	$50.10
Rate for Payer: Banner UC Health Medicaid	$260.34
Rate for Payer: Banner UC Health Medicare	$50.10
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$227.12
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$167.00
Rate for Payer: Copperpoint Commercial	$82.66
Rate for Payer: Health Net of AZ Commercial	$200.40
Rate for Payer: Health Net of AZ Medicare	$93.52
Rate for Payer: Humana of AZ Medicare	$50.10
Rate for Payer: Mercy Care Medicaid	$260.34
Rate for Payer: Self Pay Self Pay	$267.20
Rate for Payer: TriWest Medicare	$50.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.12

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

IP

$410.00

Service Code	CPT 17111
Hospital Charge Code	24049520
Hospital Revenue Code	360
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$369.00
Rate for Payer: Aetna of AZ Commercial	$369.00
Rate for Payer: Bisbee Police All Plans	$106.60
Rate for Payer: Cash Price	$328.00
Rate for Payer: Self Pay Self Pay	$328.00

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

IP

$334.00

Service Code	CPT 17110
Hospital Charge Code	24049519
Hospital Revenue Code	360
Min. Negotiated Rate	$86.84
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Bisbee Police All Plans	$86.84
Rate for Payer: Cash Price	$267.20
Rate for Payer: Self Pay Self Pay	$267.20

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

OP

$410.00

Service Code	CPT 17111
Hospital Charge Code	24049520
Hospital Revenue Code	360
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$369.00
Rate for Payer: Aetna of AZ Medicare	$114.80
Rate for Payer: AHCCCS Medicaid	$260.34
Rate for Payer: Allwell Medicaid	$260.34
Rate for Payer: Allwell Medicare	$61.50
Rate for Payer: Amerigroup Medicare	$61.50
Rate for Payer: APIPA Medicare/Medicaid	$153.14
Rate for Payer: AZCH Complete Medicaid	$260.34
Rate for Payer: AZCH Complete Medicare	$61.50
Rate for Payer: Banner UC Health Medicaid	$260.34
Rate for Payer: Banner UC Health Medicare	$61.50
Rate for Payer: Bisbee Police All Plans	$106.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$278.80
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cigna of AZ Commercial	$205.00
Rate for Payer: Copperpoint Commercial	$101.48
Rate for Payer: Health Net of AZ Commercial	$246.00
Rate for Payer: Health Net of AZ Medicare	$114.80
Rate for Payer: Humana of AZ Medicare	$61.50
Rate for Payer: Mercy Care Medicaid	$260.34
Rate for Payer: Self Pay Self Pay	$328.00
Rate for Payer: TriWest Medicare	$61.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$73.80

DETECTION TEST BY NUCLEIC ACID FOR DIGESTIVE TRACT PATHOGEN,

Facility

OP

$2,188.00

Service Code	CPT 87507
Hospital Charge Code	27658692
Hospital Revenue Code	301
Min. Negotiated Rate	$328.20
Max. Negotiated Rate	$1,969.20
Rate for Payer: Aetna of AZ Commercial	$1,969.20
Rate for Payer: Aetna of AZ Medicare	$612.64
Rate for Payer: AHCCCS Medicaid	$416.78
Rate for Payer: Allwell Medicaid	$416.78
Rate for Payer: Allwell Medicare	$328.20
Rate for Payer: Amerigroup Medicare	$328.20
Rate for Payer: APIPA Medicare/Medicaid	$817.22
Rate for Payer: AZCH Complete Medicaid	$416.78
Rate for Payer: AZCH Complete Medicare	$328.20
Rate for Payer: Banner UC Health Medicaid	$416.78
Rate for Payer: Banner UC Health Medicare	$328.20
Rate for Payer: Bisbee Police All Plans	$568.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,487.84
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cigna of AZ Commercial	$1,422.20
Rate for Payer: Copperpoint Commercial	$541.53
Rate for Payer: Health Net of AZ Commercial	$1,312.80
Rate for Payer: Health Net of AZ Medicare	$612.64
Rate for Payer: Humana of AZ Medicare	$328.20
Rate for Payer: Mercy Care Medicaid	$416.78
Rate for Payer: Self Pay Self Pay	$1,750.40
Rate for Payer: TriWest Medicare	$328.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,275.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$393.84

DETECTION TEST BY NUCLEIC ACID FOR DIGESTIVE TRACT PATHOGEN,

Facility

IP

$2,188.00

Service Code	CPT 87507
Hospital Charge Code	27658692
Hospital Revenue Code	301
Min. Negotiated Rate	$568.88
Max. Negotiated Rate	$1,969.20
Rate for Payer: Aetna of AZ Commercial	$1,969.20
Rate for Payer: Bisbee Police All Plans	$568.88
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Self Pay Self Pay	$1,750.40

dexamethasone 10 mg/mL Inj Sol [CQCH]

Facility

OP

$4.07

Service Code	HCPCS J1100
Hospital Charge Code	105918016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$3.66
Rate for Payer: Aetna of AZ Commercial	$3.66
Rate for Payer: Aetna of AZ Medicare	$1.14
Rate for Payer: AHCCCS Medicaid	$0.24
Rate for Payer: Allwell Medicaid	$0.24
Rate for Payer: Allwell Medicare	$0.61
Rate for Payer: Amerigroup Medicare	$0.61
Rate for Payer: APIPA Medicare/Medicaid	$1.52
Rate for Payer: AZCH Complete Medicaid	$0.24
Rate for Payer: AZCH Complete Medicare	$0.61
Rate for Payer: Banner UC Health Medicaid	$0.24
Rate for Payer: Banner UC Health Medicare	$0.61
Rate for Payer: Bisbee Police All Plans	$1.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.77
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of AZ Commercial	$2.65
Rate for Payer: Copperpoint Commercial	$1.01
Rate for Payer: Health Net of AZ Commercial	$2.44
Rate for Payer: Health Net of AZ Medicare	$1.14
Rate for Payer: Humana of AZ Medicare	$0.61
Rate for Payer: Mercy Care Medicaid	$0.24
Rate for Payer: Self Pay Self Pay	$3.26
Rate for Payer: TriWest Medicare	$0.61
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.73

dexamethasone 10 mg/mL Inj Sol [CQCH]

Facility

IP

$4.07

Service Code	HCPCS J1100
Hospital Charge Code	105918016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$3.66
Rate for Payer: Aetna of AZ Commercial	$3.66
Rate for Payer: Bisbee Police All Plans	$1.06
Rate for Payer: Cash Price	$3.26
Rate for Payer: Self Pay Self Pay	$3.26

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