Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$4,497.38

Service Code	APR-DRG 7703
Hospital Charge Code	APRDRG7702
Min. Negotiated Rate	$4,497.38
Max. Negotiated Rate	$4,497.38
Rate for Payer: AHCCCS Medicaid	$4,497.38
Rate for Payer: Allwell Medicaid	$4,497.38
Rate for Payer: AZCH Complete Medicaid	$4,497.38
Rate for Payer: Banner UC Health Medicaid	$4,497.38
Rate for Payer: Mercy Care Medicaid	$4,497.38

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$9,774.71

Service Code	APR-DRG 7704
Hospital Charge Code	APRDRG7702
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$2,506.80

Service Code	APR-DRG 7702
Hospital Charge Code	APRDRG7703
Min. Negotiated Rate	$2,506.80
Max. Negotiated Rate	$2,506.80
Rate for Payer: AHCCCS Medicaid	$2,506.80
Rate for Payer: Allwell Medicaid	$2,506.80
Rate for Payer: AZCH Complete Medicaid	$2,506.80
Rate for Payer: Banner UC Health Medicaid	$2,506.80
Rate for Payer: Mercy Care Medicaid	$2,506.80

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$2,506.80

Service Code	APR-DRG 7702
Hospital Charge Code	APRDRG7704
Min. Negotiated Rate	$2,506.80
Max. Negotiated Rate	$2,506.80
Rate for Payer: AHCCCS Medicaid	$2,506.80
Rate for Payer: Allwell Medicaid	$2,506.80
Rate for Payer: AZCH Complete Medicaid	$2,506.80
Rate for Payer: Banner UC Health Medicaid	$2,506.80
Rate for Payer: Mercy Care Medicaid	$2,506.80

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$1,604.10

Service Code	APR-DRG 7701
Hospital Charge Code	APRDRG7704
Min. Negotiated Rate	$1,604.10
Max. Negotiated Rate	$1,604.10
Rate for Payer: AHCCCS Medicaid	$1,604.10
Rate for Payer: Allwell Medicaid	$1,604.10
Rate for Payer: AZCH Complete Medicaid	$1,604.10
Rate for Payer: Banner UC Health Medicaid	$1,604.10
Rate for Payer: Mercy Care Medicaid	$1,604.10

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$1,604.10

Service Code	APR-DRG 7701
Hospital Charge Code	APRDRG7702
Min. Negotiated Rate	$1,604.10
Max. Negotiated Rate	$1,604.10
Rate for Payer: AHCCCS Medicaid	$1,604.10
Rate for Payer: Allwell Medicaid	$1,604.10
Rate for Payer: AZCH Complete Medicaid	$1,604.10
Rate for Payer: Banner UC Health Medicaid	$1,604.10
Rate for Payer: Mercy Care Medicaid	$1,604.10

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$1,604.10

Service Code	APR-DRG 7701
Hospital Charge Code	APRDRG7701
Min. Negotiated Rate	$1,604.10
Max. Negotiated Rate	$1,604.10
Rate for Payer: AHCCCS Medicaid	$1,604.10
Rate for Payer: Allwell Medicaid	$1,604.10
Rate for Payer: AZCH Complete Medicaid	$1,604.10
Rate for Payer: Banner UC Health Medicaid	$1,604.10
Rate for Payer: Mercy Care Medicaid	$1,604.10

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$9,774.71

Service Code	APR-DRG 7704
Hospital Charge Code	APRDRG7703
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$9,774.71

Service Code	APR-DRG 7704
Hospital Charge Code	APRDRG7704
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$4,497.38

Service Code	APR-DRG 7703
Hospital Charge Code	APRDRG7704
Min. Negotiated Rate	$4,497.38
Max. Negotiated Rate	$4,497.38
Rate for Payer: AHCCCS Medicaid	$4,497.38
Rate for Payer: Allwell Medicaid	$4,497.38
Rate for Payer: AZCH Complete Medicaid	$4,497.38
Rate for Payer: Banner UC Health Medicaid	$4,497.38
Rate for Payer: Mercy Care Medicaid	$4,497.38

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$9,774.71

Service Code	APR-DRG 7704
Hospital Charge Code	APRDRG7701
Min. Negotiated Rate	$9,774.71
Max. Negotiated Rate	$9,774.71
Rate for Payer: AHCCCS Medicaid	$9,774.71
Rate for Payer: Allwell Medicaid	$9,774.71
Rate for Payer: AZCH Complete Medicaid	$9,774.71
Rate for Payer: Banner UC Health Medicaid	$9,774.71
Rate for Payer: Mercy Care Medicaid	$9,774.71

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$4,497.38

Service Code	APR-DRG 7703
Hospital Charge Code	APRDRG7703
Min. Negotiated Rate	$4,497.38
Max. Negotiated Rate	$4,497.38
Rate for Payer: AHCCCS Medicaid	$4,497.38
Rate for Payer: Allwell Medicaid	$4,497.38
Rate for Payer: AZCH Complete Medicaid	$4,497.38
Rate for Payer: Banner UC Health Medicaid	$4,497.38
Rate for Payer: Mercy Care Medicaid	$4,497.38

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$4,497.38

Service Code	APR-DRG 7703
Hospital Charge Code	APRDRG7701
Min. Negotiated Rate	$4,497.38
Max. Negotiated Rate	$4,497.38
Rate for Payer: AHCCCS Medicaid	$4,497.38
Rate for Payer: Allwell Medicaid	$4,497.38
Rate for Payer: AZCH Complete Medicaid	$4,497.38
Rate for Payer: Banner UC Health Medicaid	$4,497.38
Rate for Payer: Mercy Care Medicaid	$4,497.38

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$2,506.80

Service Code	APR-DRG 7702
Hospital Charge Code	APRDRG7702
Min. Negotiated Rate	$2,506.80
Max. Negotiated Rate	$2,506.80
Rate for Payer: AHCCCS Medicaid	$2,506.80
Rate for Payer: Allwell Medicaid	$2,506.80
Rate for Payer: AZCH Complete Medicaid	$2,506.80
Rate for Payer: Banner UC Health Medicaid	$2,506.80
Rate for Payer: Mercy Care Medicaid	$2,506.80

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$2,506.80

Service Code	APR-DRG 7702
Hospital Charge Code	APRDRG7701
Min. Negotiated Rate	$2,506.80
Max. Negotiated Rate	$2,506.80
Rate for Payer: AHCCCS Medicaid	$2,506.80
Rate for Payer: Allwell Medicaid	$2,506.80
Rate for Payer: AZCH Complete Medicaid	$2,506.80
Rate for Payer: Banner UC Health Medicaid	$2,506.80
Rate for Payer: Mercy Care Medicaid	$2,506.80

Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice

Facility

IP

$1,604.10

Service Code	APR-DRG 7701
Hospital Charge Code	APRDRG7703
Min. Negotiated Rate	$1,604.10
Max. Negotiated Rate	$1,604.10
Rate for Payer: AHCCCS Medicaid	$1,604.10
Rate for Payer: Allwell Medicaid	$1,604.10
Rate for Payer: AZCH Complete Medicaid	$1,604.10
Rate for Payer: Banner UC Health Medicaid	$1,604.10
Rate for Payer: Mercy Care Medicaid	$1,604.10

Drugs of Abuse Screen Only, Whole Blood LC

Facility

IP

$268.00

Service Code	CPT 80307
Hospital Charge Code	22510235
Hospital Revenue Code	301
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Cash Price	$214.40
Rate for Payer: Self Pay Self Pay	$214.40

Drugs of Abuse Screen Only, Whole Blood LC

Facility

OP

$268.00

Service Code	CPT 80307
Hospital Charge Code	22510235
Hospital Revenue Code	301
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Aetna of AZ Medicare	$75.04
Rate for Payer: Allwell Medicare	$42.88
Rate for Payer: Amerigroup Medicare	$42.88
Rate for Payer: APIPA Medicare/Medicaid	$100.10
Rate for Payer: AZCH Complete Medicare	$42.88
Rate for Payer: Banner UC Health Medicare	$42.88
Rate for Payer: Bisbee Police All Plans	$69.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$182.24
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$174.20
Rate for Payer: Copperpoint Commercial	$66.33
Rate for Payer: Health Net of AZ Commercial	$160.80
Rate for Payer: Health Net of AZ Medicare	$75.04
Rate for Payer: Humana of AZ Medicare	$42.88
Rate for Payer: Self Pay Self Pay	$214.40
Rate for Payer: TriWest Medicare	$42.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$156.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.24

DRY BUBBLE HUMIDIFIER

Facility

OP

$23.00

Hospital Charge Code	24153386
Hospital Revenue Code	270
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Aetna of AZ Medicare	$6.44
Rate for Payer: Allwell Medicare	$3.68
Rate for Payer: Amerigroup Medicare	$3.68
Rate for Payer: APIPA Medicare/Medicaid	$8.59
Rate for Payer: AZCH Complete Medicare	$3.68
Rate for Payer: Banner UC Health Medicare	$3.68
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$15.64
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cigna of AZ Commercial	$16.10
Rate for Payer: Copperpoint Commercial	$5.69
Rate for Payer: Health Net of AZ Commercial	$13.80
Rate for Payer: Health Net of AZ Medicare	$6.44
Rate for Payer: Humana of AZ Medicare	$3.68
Rate for Payer: Self Pay Self Pay	$18.40
Rate for Payer: TriWest Medicare	$3.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.14

DRY BUBBLE HUMIDIFIER

Facility

IP

$23.00

Hospital Charge Code	24153386
Hospital Revenue Code	270
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna of AZ Commercial	$20.70
Rate for Payer: Bisbee Police All Plans	$5.98
Rate for Payer: Cash Price	$18.40
Rate for Payer: Self Pay Self Pay	$18.40

DULoxetine 30 mg DR capsule[CQCH]

Facility

IP

$0.65

Service Code	NDC 904704461
Hospital Charge Code	223918420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of AZ Commercial	$0.59
Rate for Payer: Bisbee Police All Plans	$0.17
Rate for Payer: Cash Price	$0.52
Rate for Payer: Self Pay Self Pay	$0.52

DULoxetine 30 mg DR capsule[CQCH]

Facility

OP

$0.65

Service Code	NDC 904704461
Hospital Charge Code	223918420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.59
Rate for Payer: Aetna of AZ Commercial	$0.59
Rate for Payer: Aetna of AZ Medicare	$0.18
Rate for Payer: Allwell Medicare	$0.10
Rate for Payer: Amerigroup Medicare	$0.10
Rate for Payer: APIPA Medicare/Medicaid	$0.24
Rate for Payer: AZCH Complete Medicare	$0.10
Rate for Payer: Banner UC Health Medicare	$0.10
Rate for Payer: Bisbee Police All Plans	$0.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.44
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of AZ Commercial	$0.42
Rate for Payer: Copperpoint Commercial	$0.16
Rate for Payer: Health Net of AZ Commercial	$0.39
Rate for Payer: Health Net of AZ Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.10
Rate for Payer: Self Pay Self Pay	$0.52
Rate for Payer: TriWest Medicare	$0.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.12

DULoxetine 60 mg DR capsule [CQCH]

Facility

IP

$1.20

Service Code	NDC 68084069201
Hospital Charge Code	111166027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of AZ Commercial	$1.08
Rate for Payer: Bisbee Police All Plans	$0.31
Rate for Payer: Cash Price	$0.96
Rate for Payer: Self Pay Self Pay	$0.96

DULoxetine 60 mg DR capsule [CQCH]

Facility

OP

$1.20

Service Code	NDC 68084069201
Hospital Charge Code	111166027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$1.08
Rate for Payer: Aetna of AZ Commercial	$1.08
Rate for Payer: Aetna of AZ Medicare	$0.34
Rate for Payer: Allwell Medicare	$0.19
Rate for Payer: Amerigroup Medicare	$0.19
Rate for Payer: APIPA Medicare/Medicaid	$0.45
Rate for Payer: AZCH Complete Medicare	$0.19
Rate for Payer: Banner UC Health Medicare	$0.19
Rate for Payer: Bisbee Police All Plans	$0.31
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.82
Rate for Payer: Cash Price	$0.96
Rate for Payer: Cigna of AZ Commercial	$0.78
Rate for Payer: Copperpoint Commercial	$0.30
Rate for Payer: Health Net of AZ Commercial	$0.72
Rate for Payer: Health Net of AZ Medicare	$0.34
Rate for Payer: Humana of AZ Medicare	$0.19
Rate for Payer: Self Pay Self Pay	$0.96
Rate for Payer: TriWest Medicare	$0.19
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.22

Du Test

Facility

IP

$106.00

Service Code	CPT 86885
Hospital Charge Code	9229048
Hospital Revenue Code	302
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

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