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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$27,633.76

Service Code	APR-DRG 3031
Hospital Charge Code	APRDRG3031
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

$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

$66,449.23

Service Code	APR-DRG 3034
Hospital Charge Code	APRDRG3031
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

$51,028.95

Service Code	APR-DRG 3033
Hospital Charge Code	APRDRG3034
Min. Negotiated Rate	$51,028.95
Max. Negotiated Rate	$51,028.95
Rate for Payer: AHCCCS Medicaid	$51,028.95
Rate for Payer: Allwell Medicaid	$51,028.95
Rate for Payer: AZCH Complete Medicaid	$51,028.95
Rate for Payer: Banner UC Health Medicaid	$51,028.95
Rate for Payer: Mercy Care Medicaid	$51,028.95

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$51,028.95

Service Code	APR-DRG 3033
Hospital Charge Code	APRDRG3033
Min. Negotiated Rate	$51,028.95
Max. Negotiated Rate	$51,028.95
Rate for Payer: AHCCCS Medicaid	$51,028.95
Rate for Payer: Allwell Medicaid	$51,028.95
Rate for Payer: AZCH Complete Medicaid	$51,028.95
Rate for Payer: Banner UC Health Medicaid	$51,028.95
Rate for Payer: Mercy Care Medicaid	$51,028.95

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$66,449.23

Service Code	APR-DRG 3034
Hospital Charge Code	APRDRG3034
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	APRDRG3033
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

$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

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$35,683.73

Service Code	APR-DRG 3032
Hospital Charge Code	APRDRG3032
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

$51,028.95

Service Code	APR-DRG 3033
Hospital Charge Code	APRDRG3031
Min. Negotiated Rate	$51,028.95
Max. Negotiated Rate	$51,028.95
Rate for Payer: AHCCCS Medicaid	$51,028.95
Rate for Payer: Allwell Medicaid	$51,028.95
Rate for Payer: AZCH Complete Medicaid	$51,028.95
Rate for Payer: Banner UC Health Medicaid	$51,028.95
Rate for Payer: Mercy Care Medicaid	$51,028.95

Dorsal And Lumbar Fusion Procedure For Curvature Of Back

Facility

IP

$51,028.95

Service Code	APR-DRG 3033
Hospital Charge Code	APRDRG3032
Min. Negotiated Rate	$51,028.95
Max. Negotiated Rate	$51,028.95
Rate for Payer: AHCCCS Medicaid	$51,028.95
Rate for Payer: Allwell Medicaid	$51,028.95
Rate for Payer: AZCH Complete Medicaid	$51,028.95
Rate for Payer: Banner UC Health Medicaid	$51,028.95
Rate for Payer: Mercy Care Medicaid	$51,028.95

doxazosin 2 mg Tab [CQCH]

Facility

IP

$3.24

Service Code	NDC 51079095820
Hospital Charge Code	105919979
Hospital Revenue Code	251
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of AZ Commercial	$2.92
Rate for Payer: Bisbee Police All Plans	$0.84
Rate for Payer: Cash Price	$2.59
Rate for Payer: Self Pay Self Pay	$2.59

doxazosin 2 mg Tab [CQCH]

Facility

OP

$3.24

Service Code	NDC 51079095820
Hospital Charge Code	105919979
Hospital Revenue Code	251
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna of AZ Commercial	$2.92
Rate for Payer: Aetna of AZ Medicare	$0.91
Rate for Payer: Allwell Medicare	$0.49
Rate for Payer: Amerigroup Medicare	$0.49
Rate for Payer: APIPA Medicare/Medicaid	$1.21
Rate for Payer: AZCH Complete Medicare	$0.49
Rate for Payer: Banner UC Health Medicare	$0.49
Rate for Payer: Bisbee Police All Plans	$0.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.20
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cigna of AZ Commercial	$2.11
Rate for Payer: Copperpoint Commercial	$0.80
Rate for Payer: Health Net of AZ Commercial	$1.94
Rate for Payer: Health Net of AZ Medicare	$0.91
Rate for Payer: Humana of AZ Medicare	$0.49
Rate for Payer: Self Pay Self Pay	$2.59
Rate for Payer: TriWest Medicare	$0.49
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.58

doxepin 25 mg Cap [CQCH]

Facility

OP

$0.37

Service Code	NDC 51079043720
Hospital Charge Code	105920044
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.33
Rate for Payer: Aetna of AZ Commercial	$0.33
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.14
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.25
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of AZ Commercial	$0.24
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.22
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.30
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

doxepin 25 mg Cap [CQCH]

Facility

IP

$0.37

Service Code	NDC 51079043720
Hospital Charge Code	105920044
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.33
Rate for Payer: Aetna of AZ Commercial	$0.33
Rate for Payer: Bisbee Police All Plans	$0.10
Rate for Payer: Cash Price	$0.30
Rate for Payer: Self Pay Self Pay	$0.30

doxycycline 100 mg IV Inj [CQCH]

Facility

OP

$17.21

Service Code	NDC 63323013017
Hospital Charge Code	105920170
Hospital Revenue Code	251
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna of AZ Commercial	$15.49
Rate for Payer: Aetna of AZ Medicare	$4.82
Rate for Payer: Allwell Medicare	$2.58
Rate for Payer: Amerigroup Medicare	$2.58
Rate for Payer: APIPA Medicare/Medicaid	$6.43
Rate for Payer: AZCH Complete Medicare	$2.58
Rate for Payer: Banner UC Health Medicare	$2.58
Rate for Payer: Bisbee Police All Plans	$4.47
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$11.70
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cigna of AZ Commercial	$11.19
Rate for Payer: Copperpoint Commercial	$4.26
Rate for Payer: Health Net of AZ Commercial	$10.33
Rate for Payer: Health Net of AZ Medicare	$4.82
Rate for Payer: Humana of AZ Medicare	$2.58
Rate for Payer: Self Pay Self Pay	$13.77
Rate for Payer: TriWest Medicare	$2.58
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.10

doxycycline 100 mg IV Inj [CQCH]

Facility

IP

$17.21

Service Code	NDC 63323013017
Hospital Charge Code	105920170
Hospital Revenue Code	251
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna of AZ Commercial	$15.49
Rate for Payer: Bisbee Police All Plans	$4.47
Rate for Payer: Cash Price	$13.77
Rate for Payer: Self Pay Self Pay	$13.77

doxycycline 100 mg Tab UD [CQCH]

Facility

OP

$1.09

Service Code	NDC 904043006
Hospital Charge Code	108072609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of AZ Commercial	$0.98
Rate for Payer: Aetna of AZ Medicare	$0.31
Rate for Payer: Allwell Medicare	$0.16
Rate for Payer: Amerigroup Medicare	$0.16
Rate for Payer: APIPA Medicare/Medicaid	$0.41
Rate for Payer: AZCH Complete Medicare	$0.16
Rate for Payer: Banner UC Health Medicare	$0.16
Rate for Payer: Bisbee Police All Plans	$0.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.74
Rate for Payer: Cash Price	$0.87
Rate for Payer: Cigna of AZ Commercial	$0.71
Rate for Payer: Copperpoint Commercial	$0.27
Rate for Payer: Health Net of AZ Commercial	$0.65
Rate for Payer: Health Net of AZ Medicare	$0.31
Rate for Payer: Humana of AZ Medicare	$0.16
Rate for Payer: Self Pay Self Pay	$0.87
Rate for Payer: TriWest Medicare	$0.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.20

doxycycline 100 mg Tab UD [CQCH]

Facility

IP

$1.09

Service Code	NDC 904043006
Hospital Charge Code	108072609
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of AZ Commercial	$0.98
Rate for Payer: Bisbee Police All Plans	$0.28
Rate for Payer: Cash Price	$0.87
Rate for Payer: Self Pay Self Pay	$0.87

Drainage of Ovarian Cyst abd

Facility

OP

$2,321.00

Service Code	CPT 58805
Hospital Charge Code	27281893
Hospital Revenue Code	360
Min. Negotiated Rate	$348.15
Max. Negotiated Rate	$3,803.66
Rate for Payer: Aetna of AZ Commercial	$2,088.90
Rate for Payer: Aetna of AZ Medicare	$649.88
Rate for Payer: AHCCCS Medicaid	$3,803.66
Rate for Payer: Allwell Medicaid	$3,803.66
Rate for Payer: Allwell Medicare	$348.15
Rate for Payer: Amerigroup Medicare	$348.15
Rate for Payer: APIPA Medicare/Medicaid	$866.89
Rate for Payer: AZCH Complete Medicaid	$3,803.66
Rate for Payer: AZCH Complete Medicare	$348.15
Rate for Payer: Banner UC Health Medicaid	$3,803.66
Rate for Payer: Banner UC Health Medicare	$348.15
Rate for Payer: Bisbee Police All Plans	$603.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,578.28
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Cigna of AZ Commercial	$1,160.50
Rate for Payer: Copperpoint Commercial	$574.45
Rate for Payer: Health Net of AZ Commercial	$1,392.60
Rate for Payer: Health Net of AZ Medicare	$649.88
Rate for Payer: Humana of AZ Medicare	$348.15
Rate for Payer: Mercy Care Medicaid	$3,803.66
Rate for Payer: Self Pay Self Pay	$1,856.80
Rate for Payer: TriWest Medicare	$348.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$417.78

Drainage of Ovarian Cyst abd

Facility

IP

$2,321.00

Service Code	CPT 58805
Hospital Charge Code	27281893
Hospital Revenue Code	360
Min. Negotiated Rate	$603.46
Max. Negotiated Rate	$2,088.90
Rate for Payer: Aetna of AZ Commercial	$2,088.90
Rate for Payer: Bisbee Police All Plans	$603.46
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Self Pay Self Pay	$1,856.80

Drainage of Ovariona Abscess abd

Facility

IP

$3,896.00

Service Code	CPT 58822
Hospital Charge Code	27281894
Hospital Revenue Code	360
Min. Negotiated Rate	$1,012.96
Max. Negotiated Rate	$3,506.40
Rate for Payer: Aetna of AZ Commercial	$3,506.40
Rate for Payer: Bisbee Police All Plans	$1,012.96
Rate for Payer: Cash Price	$3,116.80
Rate for Payer: Self Pay Self Pay	$3,116.80

Drainage of Ovariona Abscess abd

Facility

OP

$3,896.00

Service Code	CPT 58822
Hospital Charge Code	27281894
Hospital Revenue Code	360
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$3,506.40
Rate for Payer: Aetna of AZ Medicare	$1,090.88
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$584.40
Rate for Payer: Amerigroup Medicare	$584.40
Rate for Payer: APIPA Medicare/Medicaid	$1,455.16
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$584.40
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$584.40
Rate for Payer: Bisbee Police All Plans	$1,012.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,649.28
Rate for Payer: Cash Price	$3,116.80
Rate for Payer: Cash Price	$3,116.80
Rate for Payer: Cigna of AZ Commercial	$1,948.00
Rate for Payer: Copperpoint Commercial	$964.26
Rate for Payer: Health Net of AZ Commercial	$2,337.60
Rate for Payer: Health Net of AZ Medicare	$1,090.88
Rate for Payer: Humana of AZ Medicare	$584.40
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$3,116.80
Rate for Payer: TriWest Medicare	$584.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$701.28

Drainage of Pelvic Abscess

Facility

OP

$700.00

Service Code	CPT 10030
Hospital Charge Code	27267827
Hospital Revenue Code	360
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Aetna of AZ Medicare	$196.00
Rate for Payer: AHCCCS Medicaid	$901.86
Rate for Payer: Allwell Medicaid	$901.86
Rate for Payer: Allwell Medicare	$105.00
Rate for Payer: Amerigroup Medicare	$105.00
Rate for Payer: APIPA Medicare/Medicaid	$261.45
Rate for Payer: AZCH Complete Medicaid	$901.86
Rate for Payer: AZCH Complete Medicare	$105.00
Rate for Payer: Banner UC Health Medicaid	$901.86
Rate for Payer: Banner UC Health Medicare	$105.00
Rate for Payer: Bisbee Police All Plans	$182.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$476.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cigna of AZ Commercial	$350.00
Rate for Payer: Copperpoint Commercial	$173.25
Rate for Payer: Health Net of AZ Commercial	$420.00
Rate for Payer: Health Net of AZ Medicare	$196.00
Rate for Payer: Humana of AZ Medicare	$105.00
Rate for Payer: Mercy Care Medicaid	$901.86
Rate for Payer: Self Pay Self Pay	$560.00
Rate for Payer: TriWest Medicare	$105.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$126.00

Drainage of Pelvic Abscess

Facility

IP

$700.00

Service Code	CPT 10030
Hospital Charge Code	27267827
Hospital Revenue Code	360
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna of AZ Commercial	$630.00
Rate for Payer: Bisbee Police All Plans	$182.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Self Pay Self Pay	$560.00

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