Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Diverticulitis And Diverticulosis

Facility

IP

$4,484.75

Service Code	APR-DRG 2442
Hospital Charge Code	APRDRG2444
Min. Negotiated Rate	$4,484.75
Max. Negotiated Rate	$4,484.75
Rate for Payer: AHCCCS Medicaid	$4,484.75
Rate for Payer: Allwell Medicaid	$4,484.75
Rate for Payer: AZCH Complete Medicaid	$4,484.75
Rate for Payer: Banner UC Health Medicaid	$4,484.75
Rate for Payer: Mercy Care Medicaid	$4,484.75

Diverticulitis And Diverticulosis

Facility

IP

$6,993.66

Service Code	APR-DRG 2443
Hospital Charge Code	APRDRG2441
Min. Negotiated Rate	$6,993.66
Max. Negotiated Rate	$6,993.66
Rate for Payer: AHCCCS Medicaid	$6,993.66
Rate for Payer: Allwell Medicaid	$6,993.66
Rate for Payer: AZCH Complete Medicaid	$6,993.66
Rate for Payer: Banner UC Health Medicaid	$6,993.66
Rate for Payer: Mercy Care Medicaid	$6,993.66

Diverticulitis And Diverticulosis

Facility

IP

$4,484.75

Service Code	APR-DRG 2442
Hospital Charge Code	APRDRG2442
Min. Negotiated Rate	$4,484.75
Max. Negotiated Rate	$4,484.75
Rate for Payer: AHCCCS Medicaid	$4,484.75
Rate for Payer: Allwell Medicaid	$4,484.75
Rate for Payer: AZCH Complete Medicaid	$4,484.75
Rate for Payer: Banner UC Health Medicaid	$4,484.75
Rate for Payer: Mercy Care Medicaid	$4,484.75

Diverticulitis And Diverticulosis

Facility

IP

$13,498.44

Service Code	APR-DRG 2444
Hospital Charge Code	APRDRG2443
Min. Negotiated Rate	$13,498.44
Max. Negotiated Rate	$13,498.44
Rate for Payer: AHCCCS Medicaid	$13,498.44
Rate for Payer: Allwell Medicaid	$13,498.44
Rate for Payer: AZCH Complete Medicaid	$13,498.44
Rate for Payer: Banner UC Health Medicaid	$13,498.44
Rate for Payer: Mercy Care Medicaid	$13,498.44

Diverticulitis And Diverticulosis

Facility

IP

$4,484.75

Service Code	APR-DRG 2442
Hospital Charge Code	APRDRG2443
Min. Negotiated Rate	$4,484.75
Max. Negotiated Rate	$4,484.75
Rate for Payer: AHCCCS Medicaid	$4,484.75
Rate for Payer: Allwell Medicaid	$4,484.75
Rate for Payer: AZCH Complete Medicaid	$4,484.75
Rate for Payer: Banner UC Health Medicaid	$4,484.75
Rate for Payer: Mercy Care Medicaid	$4,484.75

Diverticulitis And Diverticulosis

Facility

IP

$13,498.44

Service Code	APR-DRG 2444
Hospital Charge Code	APRDRG2444
Min. Negotiated Rate	$13,498.44
Max. Negotiated Rate	$13,498.44
Rate for Payer: AHCCCS Medicaid	$13,498.44
Rate for Payer: Allwell Medicaid	$13,498.44
Rate for Payer: AZCH Complete Medicaid	$13,498.44
Rate for Payer: Banner UC Health Medicaid	$13,498.44
Rate for Payer: Mercy Care Medicaid	$13,498.44

Diverticulitis And Diverticulosis

Facility

IP

$3,380.05

Service Code	APR-DRG 2441
Hospital Charge Code	APRDRG2444
Min. Negotiated Rate	$3,380.05
Max. Negotiated Rate	$3,380.05
Rate for Payer: AHCCCS Medicaid	$3,380.05
Rate for Payer: Allwell Medicaid	$3,380.05
Rate for Payer: AZCH Complete Medicaid	$3,380.05
Rate for Payer: Banner UC Health Medicaid	$3,380.05
Rate for Payer: Mercy Care Medicaid	$3,380.05

Diverticulitis And Diverticulosis

Facility

IP

$3,380.05

Service Code	APR-DRG 2441
Hospital Charge Code	APRDRG2442
Min. Negotiated Rate	$3,380.05
Max. Negotiated Rate	$3,380.05
Rate for Payer: AHCCCS Medicaid	$3,380.05
Rate for Payer: Allwell Medicaid	$3,380.05
Rate for Payer: AZCH Complete Medicaid	$3,380.05
Rate for Payer: Banner UC Health Medicaid	$3,380.05
Rate for Payer: Mercy Care Medicaid	$3,380.05

Diverticulitis And Diverticulosis

Facility

IP

$13,498.44

Service Code	APR-DRG 2444
Hospital Charge Code	APRDRG2441
Min. Negotiated Rate	$13,498.44
Max. Negotiated Rate	$13,498.44
Rate for Payer: AHCCCS Medicaid	$13,498.44
Rate for Payer: Allwell Medicaid	$13,498.44
Rate for Payer: AZCH Complete Medicaid	$13,498.44
Rate for Payer: Banner UC Health Medicaid	$13,498.44
Rate for Payer: Mercy Care Medicaid	$13,498.44

Diverticulitis And Diverticulosis

Facility

IP

$13,498.44

Service Code	APR-DRG 2444
Hospital Charge Code	APRDRG2442
Min. Negotiated Rate	$13,498.44
Max. Negotiated Rate	$13,498.44
Rate for Payer: AHCCCS Medicaid	$13,498.44
Rate for Payer: Allwell Medicaid	$13,498.44
Rate for Payer: AZCH Complete Medicaid	$13,498.44
Rate for Payer: Banner UC Health Medicaid	$13,498.44
Rate for Payer: Mercy Care Medicaid	$13,498.44

Diverticulitis And Diverticulosis

Facility

IP

$6,993.66

Service Code	APR-DRG 2443
Hospital Charge Code	APRDRG2444
Min. Negotiated Rate	$6,993.66
Max. Negotiated Rate	$6,993.66
Rate for Payer: AHCCCS Medicaid	$6,993.66
Rate for Payer: Allwell Medicaid	$6,993.66
Rate for Payer: AZCH Complete Medicaid	$6,993.66
Rate for Payer: Banner UC Health Medicaid	$6,993.66
Rate for Payer: Mercy Care Medicaid	$6,993.66

Diverticulitis And Diverticulosis

Facility

IP

$6,993.66

Service Code	APR-DRG 2443
Hospital Charge Code	APRDRG2443
Min. Negotiated Rate	$6,993.66
Max. Negotiated Rate	$6,993.66
Rate for Payer: AHCCCS Medicaid	$6,993.66
Rate for Payer: Allwell Medicaid	$6,993.66
Rate for Payer: AZCH Complete Medicaid	$6,993.66
Rate for Payer: Banner UC Health Medicaid	$6,993.66
Rate for Payer: Mercy Care Medicaid	$6,993.66

Diverticulitis And Diverticulosis

Facility

IP

$3,380.05

Service Code	APR-DRG 2441
Hospital Charge Code	APRDRG2441
Min. Negotiated Rate	$3,380.05
Max. Negotiated Rate	$3,380.05
Rate for Payer: AHCCCS Medicaid	$3,380.05
Rate for Payer: Allwell Medicaid	$3,380.05
Rate for Payer: AZCH Complete Medicaid	$3,380.05
Rate for Payer: Banner UC Health Medicaid	$3,380.05
Rate for Payer: Mercy Care Medicaid	$3,380.05

Diverticulitis And Diverticulosis

Facility

IP

$4,484.75

Service Code	APR-DRG 2442
Hospital Charge Code	APRDRG2441
Min. Negotiated Rate	$4,484.75
Max. Negotiated Rate	$4,484.75
Rate for Payer: AHCCCS Medicaid	$4,484.75
Rate for Payer: Allwell Medicaid	$4,484.75
Rate for Payer: AZCH Complete Medicaid	$4,484.75
Rate for Payer: Banner UC Health Medicaid	$4,484.75
Rate for Payer: Mercy Care Medicaid	$4,484.75

Diverticulitis And Diverticulosis

Facility

IP

$3,380.05

Service Code	APR-DRG 2441
Hospital Charge Code	APRDRG2443
Min. Negotiated Rate	$3,380.05
Max. Negotiated Rate	$3,380.05
Rate for Payer: AHCCCS Medicaid	$3,380.05
Rate for Payer: Allwell Medicaid	$3,380.05
Rate for Payer: AZCH Complete Medicaid	$3,380.05
Rate for Payer: Banner UC Health Medicaid	$3,380.05
Rate for Payer: Mercy Care Medicaid	$3,380.05

DMSO intravesical

Facility

OP

$168.00

Service Code	CPT 51700
Hospital Charge Code	27291812
Hospital Revenue Code	360
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Aetna of AZ Medicare	$47.04
Rate for Payer: AHCCCS Medicaid	$385.90
Rate for Payer: Allwell Medicaid	$385.90
Rate for Payer: Allwell Medicare	$25.20
Rate for Payer: Amerigroup Medicare	$25.20
Rate for Payer: APIPA Medicare/Medicaid	$62.75
Rate for Payer: AZCH Complete Medicaid	$385.90
Rate for Payer: AZCH Complete Medicare	$25.20
Rate for Payer: Banner UC Health Medicaid	$385.90
Rate for Payer: Banner UC Health Medicare	$25.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$114.24
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$84.00
Rate for Payer: Copperpoint Commercial	$41.58
Rate for Payer: Health Net of AZ Commercial	$100.80
Rate for Payer: Health Net of AZ Medicare	$47.04
Rate for Payer: Humana of AZ Medicare	$25.20
Rate for Payer: Mercy Care Medicaid	$385.90
Rate for Payer: Self Pay Self Pay	$134.40
Rate for Payer: TriWest Medicare	$25.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.24

DMSO intravesical

Facility

IP

$168.00

Service Code	CPT 51700
Hospital Charge Code	27291812
Hospital Revenue Code	360
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Cash Price	$134.40
Rate for Payer: Self Pay Self Pay	$134.40

DOBUTamine 12.5 mg/mL Sol[CQCH]

Facility

OP

$0.25

Service Code	HCPCS J1250
Hospital Charge Code	141138221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Aetna of AZ Medicare	$0.07
Rate for Payer: AHCCCS Medicaid	$13.24
Rate for Payer: Allwell Medicaid	$13.24
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.09
Rate for Payer: AZCH Complete Medicaid	$13.24
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicaid	$13.24
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.17
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.15
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Mercy Care Medicaid	$13.24
Rate for Payer: Self Pay Self Pay	$0.20
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

DOBUTamine 12.5 mg/mL Sol[CQCH]

Facility

IP

$0.25

Service Code	HCPCS J1250
Hospital Charge Code	141138221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.20
Rate for Payer: Self Pay Self Pay	$0.20

DOBUTamine 1 mg/mL- 250 mL IVPB [CQCH]

Facility

OP

$0.07

Service Code	HCPCS J1250
Hospital Charge Code	105919638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: AHCCCS Medicaid	$13.24
Rate for Payer: Allwell Medicaid	$13.24
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicaid	$13.24
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicaid	$13.24
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Mercy Care Medicaid	$13.24
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

DOBUTamine 1 mg/mL- 250 mL IVPB [CQCH]

Facility

IP

$0.07

Service Code	HCPCS J1250
Hospital Charge Code	105919638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

docusate sodium 100 mg/10 mL Oral Liq [CQCH]

Facility

OP

$0.03

Service Code	NDC 121054410
Hospital Charge Code	105919774
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

docusate sodium 100 mg/10 mL Oral Liq [CQCH]

Facility

IP

$0.03

Service Code	NDC 121054410
Hospital Charge Code	105919774
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

docusate sodium 100 mg Cap [CQCH]

Facility

OP

$0.03

Service Code	NDC 904645561
Hospital Charge Code	105919709
Hospital Revenue Code	251
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.02
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

docusate sodium 100 mg Cap [CQCH]

Facility

IP

$0.03

Service Code	NDC 904645561
Hospital Charge Code	105919709
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

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