Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DENTURE ADHESIVE

Facility

OP

$14.00

Hospital Charge Code	22781968
Hospital Revenue Code	272
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Aetna of AZ Medicare	$3.92
Rate for Payer: Allwell Medicare	$2.24
Rate for Payer: Amerigroup Medicare	$2.24
Rate for Payer: APIPA Medicare/Medicaid	$5.23
Rate for Payer: AZCH Complete Medicare	$2.24
Rate for Payer: Banner UC Health Medicare	$2.24
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$9.52
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of AZ Commercial	$9.80
Rate for Payer: Copperpoint Commercial	$3.46
Rate for Payer: Health Net of AZ Commercial	$8.40
Rate for Payer: Health Net of AZ Medicare	$3.92
Rate for Payer: Humana of AZ Medicare	$2.24
Rate for Payer: Self Pay Self Pay	$11.20
Rate for Payer: TriWest Medicare	$2.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$8.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.52

DENTURE ADHESIVE

Facility

IP

$14.00

Hospital Charge Code	22781968
Hospital Revenue Code	272
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna of AZ Commercial	$12.60
Rate for Payer: Bisbee Police All Plans	$3.64
Rate for Payer: Cash Price	$11.20
Rate for Payer: Self Pay Self Pay	$11.20

DEPO-Medrol 40 mg/1 mL Inj Susp [CQCH]

Facility

OP

$6.50

Service Code	HCPCS J1030
Hospital Charge Code	105931516
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$5.85
Rate for Payer: Aetna of AZ Commercial	$5.85
Rate for Payer: Aetna of AZ Medicare	$1.82
Rate for Payer: Allwell Medicare	$1.04
Rate for Payer: Amerigroup Medicare	$1.04
Rate for Payer: APIPA Medicare/Medicaid	$2.43
Rate for Payer: AZCH Complete Medicare	$1.04
Rate for Payer: Banner UC Health Medicare	$1.04
Rate for Payer: Bisbee Police All Plans	$1.69
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.42
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna of AZ Commercial	$4.22
Rate for Payer: Copperpoint Commercial	$1.61
Rate for Payer: Health Net of AZ Commercial	$3.90
Rate for Payer: Health Net of AZ Medicare	$1.82
Rate for Payer: Humana of AZ Medicare	$1.04
Rate for Payer: Self Pay Self Pay	$5.20
Rate for Payer: TriWest Medicare	$1.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.17

DEPO-Medrol 40 mg/1 mL Inj Susp [CQCH]

Facility

IP

$6.50

Service Code	HCPCS J1030
Hospital Charge Code	105931516
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$5.85
Rate for Payer: Aetna of AZ Commercial	$5.85
Rate for Payer: Bisbee Police All Plans	$1.69
Rate for Payer: Cash Price	$5.20
Rate for Payer: Self Pay Self Pay	$5.20

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	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

$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

$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

Depression Except Major Depressive Disorder

Facility

IP

$2,837.16

Service Code	APR-DRG 7542
Hospital Charge Code	APRDRG7542
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

$2,042.48

Service Code	APR-DRG 7541
Hospital Charge Code	APRDRG7544
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	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	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

$2,042.48

Service Code	APR-DRG 7541
Hospital Charge Code	APRDRG7541
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

$4,831.94

Service Code	APR-DRG 7543
Hospital Charge Code	APRDRG7544
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

$2,837.16

Service Code	APR-DRG 7542
Hospital Charge Code	APRDRG7543
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

$2,042.48

Service Code	APR-DRG 7541
Hospital Charge Code	APRDRG7543
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

$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

$10,887.13

Service Code	APR-DRG 7544
Hospital Charge Code	APRDRG7544
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	$16.80
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	$16.80
Rate for Payer: Amerigroup Medicare	$16.80
Rate for Payer: APIPA Medicare/Medicaid	$39.22
Rate for Payer: AZCH Complete Medicare	$16.80
Rate for Payer: Banner UC Health Medicare	$16.80
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	$16.80
Rate for Payer: Self Pay Self Pay	$84.00
Rate for Payer: TriWest Medicare	$16.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.90

DERMAGRAFT

Facility

OP

$309.00

Service Code	CPT Q4106
Hospital Charge Code	24358082
Hospital Revenue Code	636
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Aetna of AZ Medicare	$86.52
Rate for Payer: Allwell Medicare	$49.44
Rate for Payer: Amerigroup Medicare	$49.44
Rate for Payer: APIPA Medicare/Medicaid	$115.41
Rate for Payer: AZCH Complete Medicare	$49.44
Rate for Payer: Banner UC Health Medicare	$49.44
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.12
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$216.30
Rate for Payer: Copperpoint Commercial	$76.48
Rate for Payer: Health Net of AZ Commercial	$185.40
Rate for Payer: Health Net of AZ Medicare	$86.52
Rate for Payer: Humana of AZ Medicare	$49.44
Rate for Payer: Self Pay Self Pay	$247.20
Rate for Payer: TriWest Medicare	$49.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.62

DERMAGRAFT

Facility

IP

$309.00

Service Code	CPT Q4106
Hospital Charge Code	24358082
Hospital Revenue Code	636
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Cash Price	$247.20
Rate for Payer: Self Pay Self Pay	$247.20

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

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