Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

donepezil 5 mg Tab [CQCH]

Facility

IP

$0.11

Service Code	NDC 60687029201
Hospital Charge Code	105919841
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.08
Rate for Payer: Self Pay Self Pay	$0.09

donepezil 5 mg Tab [CQCH]

Facility

OP

$0.11

Service Code	NDC 60687029201
Hospital Charge Code	105919841
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna of AZ Commercial	$0.10
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.07
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of AZ Commercial	$0.07
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.09
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

DOPamine 1.6 mg/mL-250 mL IVPB [CQCH]

Facility

OP

$0.03

Service Code	HCPCS J1265
Hospital Charge Code	105919908
Hospital Revenue Code	250
Max. Negotiated Rate	$1.18
Rate for Payer: Aetna of AZ Commercial	$0.03
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: AHCCCS Medicaid	$1.18
Rate for Payer: Allwell Medicaid	$1.18
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 Medicaid	$1.18
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicaid	$1.18
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: 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: Mercy Care Medicaid	$1.18
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

DOPamine 1.6 mg/mL-250 mL IVPB [CQCH]

Facility

IP

$0.03

Service Code	HCPCS J1265
Hospital Charge Code	105919908
Hospital Revenue Code	250
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

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$47,588.59

Service Code	APR-DRG 3044
Hospital Charge Code	APRDRG3042
Min. Negotiated Rate	$47,588.59
Max. Negotiated Rate	$47,588.59
Rate for Payer: AHCCCS Medicaid	$47,588.59
Rate for Payer: Allwell Medicaid	$47,588.59
Rate for Payer: AZCH Complete Medicaid	$47,588.59
Rate for Payer: Banner UC Health Medicaid	$47,588.59
Rate for Payer: Mercy Care Medicaid	$47,588.59

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$21,589.09

Service Code	APR-DRG 3042
Hospital Charge Code	APRDRG3042
Min. Negotiated Rate	$21,589.09
Max. Negotiated Rate	$21,589.09
Rate for Payer: AHCCCS Medicaid	$21,589.09
Rate for Payer: Allwell Medicaid	$21,589.09
Rate for Payer: AZCH Complete Medicaid	$21,589.09
Rate for Payer: Banner UC Health Medicaid	$21,589.09
Rate for Payer: Mercy Care Medicaid	$21,589.09

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$47,588.59

Service Code	APR-DRG 3044
Hospital Charge Code	APRDRG3044
Min. Negotiated Rate	$47,588.59
Max. Negotiated Rate	$47,588.59
Rate for Payer: AHCCCS Medicaid	$47,588.59
Rate for Payer: Allwell Medicaid	$47,588.59
Rate for Payer: AZCH Complete Medicaid	$47,588.59
Rate for Payer: Banner UC Health Medicaid	$47,588.59
Rate for Payer: Mercy Care Medicaid	$47,588.59

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$21,589.09

Service Code	APR-DRG 3042
Hospital Charge Code	APRDRG3044
Min. Negotiated Rate	$21,589.09
Max. Negotiated Rate	$21,589.09
Rate for Payer: AHCCCS Medicaid	$21,589.09
Rate for Payer: Allwell Medicaid	$21,589.09
Rate for Payer: AZCH Complete Medicaid	$21,589.09
Rate for Payer: Banner UC Health Medicaid	$21,589.09
Rate for Payer: Mercy Care Medicaid	$21,589.09

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$17,155.54

Service Code	APR-DRG 3041
Hospital Charge Code	APRDRG3042
Min. Negotiated Rate	$17,155.54
Max. Negotiated Rate	$17,155.54
Rate for Payer: AHCCCS Medicaid	$17,155.54
Rate for Payer: Allwell Medicaid	$17,155.54
Rate for Payer: AZCH Complete Medicaid	$17,155.54
Rate for Payer: Banner UC Health Medicaid	$17,155.54
Rate for Payer: Mercy Care Medicaid	$17,155.54

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$21,589.09

Service Code	APR-DRG 3042
Hospital Charge Code	APRDRG3041
Min. Negotiated Rate	$21,589.09
Max. Negotiated Rate	$21,589.09
Rate for Payer: AHCCCS Medicaid	$21,589.09
Rate for Payer: Allwell Medicaid	$21,589.09
Rate for Payer: AZCH Complete Medicaid	$21,589.09
Rate for Payer: Banner UC Health Medicaid	$21,589.09
Rate for Payer: Mercy Care Medicaid	$21,589.09

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$17,155.54

Service Code	APR-DRG 3041
Hospital Charge Code	APRDRG3044
Min. Negotiated Rate	$17,155.54
Max. Negotiated Rate	$17,155.54
Rate for Payer: AHCCCS Medicaid	$17,155.54
Rate for Payer: Allwell Medicaid	$17,155.54
Rate for Payer: AZCH Complete Medicaid	$17,155.54
Rate for Payer: Banner UC Health Medicaid	$17,155.54
Rate for Payer: Mercy Care Medicaid	$17,155.54

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$32,927.92

Service Code	APR-DRG 3043
Hospital Charge Code	APRDRG3042
Min. Negotiated Rate	$32,927.92
Max. Negotiated Rate	$32,927.92
Rate for Payer: AHCCCS Medicaid	$32,927.92
Rate for Payer: Allwell Medicaid	$32,927.92
Rate for Payer: AZCH Complete Medicaid	$32,927.92
Rate for Payer: Banner UC Health Medicaid	$32,927.92
Rate for Payer: Mercy Care Medicaid	$32,927.92

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$32,927.92

Service Code	APR-DRG 3043
Hospital Charge Code	APRDRG3044
Min. Negotiated Rate	$32,927.92
Max. Negotiated Rate	$32,927.92
Rate for Payer: AHCCCS Medicaid	$32,927.92
Rate for Payer: Allwell Medicaid	$32,927.92
Rate for Payer: AZCH Complete Medicaid	$32,927.92
Rate for Payer: Banner UC Health Medicaid	$32,927.92
Rate for Payer: Mercy Care Medicaid	$32,927.92

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$47,588.59

Service Code	APR-DRG 3044
Hospital Charge Code	APRDRG3041
Min. Negotiated Rate	$47,588.59
Max. Negotiated Rate	$47,588.59
Rate for Payer: AHCCCS Medicaid	$47,588.59
Rate for Payer: Allwell Medicaid	$47,588.59
Rate for Payer: AZCH Complete Medicaid	$47,588.59
Rate for Payer: Banner UC Health Medicaid	$47,588.59
Rate for Payer: Mercy Care Medicaid	$47,588.59

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$32,927.92

Service Code	APR-DRG 3043
Hospital Charge Code	APRDRG3043
Min. Negotiated Rate	$32,927.92
Max. Negotiated Rate	$32,927.92
Rate for Payer: AHCCCS Medicaid	$32,927.92
Rate for Payer: Allwell Medicaid	$32,927.92
Rate for Payer: AZCH Complete Medicaid	$32,927.92
Rate for Payer: Banner UC Health Medicaid	$32,927.92
Rate for Payer: Mercy Care Medicaid	$32,927.92

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$32,927.92

Service Code	APR-DRG 3043
Hospital Charge Code	APRDRG3041
Min. Negotiated Rate	$32,927.92
Max. Negotiated Rate	$32,927.92
Rate for Payer: AHCCCS Medicaid	$32,927.92
Rate for Payer: Allwell Medicaid	$32,927.92
Rate for Payer: AZCH Complete Medicaid	$32,927.92
Rate for Payer: Banner UC Health Medicaid	$32,927.92
Rate for Payer: Mercy Care Medicaid	$32,927.92

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$21,589.09

Service Code	APR-DRG 3042
Hospital Charge Code	APRDRG3043
Min. Negotiated Rate	$21,589.09
Max. Negotiated Rate	$21,589.09
Rate for Payer: AHCCCS Medicaid	$21,589.09
Rate for Payer: Allwell Medicaid	$21,589.09
Rate for Payer: AZCH Complete Medicaid	$21,589.09
Rate for Payer: Banner UC Health Medicaid	$21,589.09
Rate for Payer: Mercy Care Medicaid	$21,589.09

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$17,155.54

Service Code	APR-DRG 3041
Hospital Charge Code	APRDRG3043
Min. Negotiated Rate	$17,155.54
Max. Negotiated Rate	$17,155.54
Rate for Payer: AHCCCS Medicaid	$17,155.54
Rate for Payer: Allwell Medicaid	$17,155.54
Rate for Payer: AZCH Complete Medicaid	$17,155.54
Rate for Payer: Banner UC Health Medicaid	$17,155.54
Rate for Payer: Mercy Care Medicaid	$17,155.54

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$17,155.54

Service Code	APR-DRG 3041
Hospital Charge Code	APRDRG3041
Min. Negotiated Rate	$17,155.54
Max. Negotiated Rate	$17,155.54
Rate for Payer: AHCCCS Medicaid	$17,155.54
Rate for Payer: Allwell Medicaid	$17,155.54
Rate for Payer: AZCH Complete Medicaid	$17,155.54
Rate for Payer: Banner UC Health Medicaid	$17,155.54
Rate for Payer: Mercy Care Medicaid	$17,155.54

Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back

Facility

IP

$47,588.59

Service Code	APR-DRG 3044
Hospital Charge Code	APRDRG3043
Min. Negotiated Rate	$47,588.59
Max. Negotiated Rate	$47,588.59
Rate for Payer: AHCCCS Medicaid	$47,588.59
Rate for Payer: Allwell Medicaid	$47,588.59
Rate for Payer: AZCH Complete Medicaid	$47,588.59
Rate for Payer: Banner UC Health Medicaid	$47,588.59
Rate for Payer: Mercy Care Medicaid	$47,588.59

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$27,633.76

Service Code	APR-DRG 3031
Hospital Charge Code	APRDRG3032
Min. Negotiated Rate	$27,633.76
Max. Negotiated Rate	$27,633.76
Rate for Payer: AHCCCS Medicaid	$27,633.76
Rate for Payer: Allwell Medicaid	$27,633.76
Rate for Payer: AZCH Complete Medicaid	$27,633.76
Rate for Payer: Banner UC Health Medicaid	$27,633.76
Rate for Payer: Mercy Care Medicaid	$27,633.76

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$35,683.73

Service Code	APR-DRG 3032
Hospital Charge Code	APRDRG3031
Min. Negotiated Rate	$35,683.73
Max. Negotiated Rate	$35,683.73
Rate for Payer: AHCCCS Medicaid	$35,683.73
Rate for Payer: Allwell Medicaid	$35,683.73
Rate for Payer: AZCH Complete Medicaid	$35,683.73
Rate for Payer: Banner UC Health Medicaid	$35,683.73
Rate for Payer: Mercy Care Medicaid	$35,683.73

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$66,449.23

Service Code	APR-DRG 3034
Hospital Charge Code	APRDRG3032
Min. Negotiated Rate	$66,449.23
Max. Negotiated Rate	$66,449.23
Rate for Payer: AHCCCS Medicaid	$66,449.23
Rate for Payer: Allwell Medicaid	$66,449.23
Rate for Payer: AZCH Complete Medicaid	$66,449.23
Rate for Payer: Banner UC Health Medicaid	$66,449.23
Rate for Payer: Mercy Care Medicaid	$66,449.23

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$66,449.23

Service Code	APR-DRG 3034
Hospital Charge Code	APRDRG3033
Min. Negotiated Rate	$66,449.23
Max. Negotiated Rate	$66,449.23
Rate for Payer: AHCCCS Medicaid	$66,449.23
Rate for Payer: Allwell Medicaid	$66,449.23
Rate for Payer: AZCH Complete Medicaid	$66,449.23
Rate for Payer: Banner UC Health Medicaid	$66,449.23
Rate for Payer: Mercy Care Medicaid	$66,449.23

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$27,633.76

Service Code	APR-DRG 3031
Hospital Charge Code	APRDRG3034
Min. Negotiated Rate	$27,633.76
Max. Negotiated Rate	$27,633.76
Rate for Payer: AHCCCS Medicaid	$27,633.76
Rate for Payer: Allwell Medicaid	$27,633.76
Rate for Payer: AZCH Complete Medicaid	$27,633.76
Rate for Payer: Banner UC Health Medicaid	$27,633.76
Rate for Payer: Mercy Care Medicaid	$27,633.76

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