Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ketorolac 30 mg Inj Sol [CQCH]

Facility

IP

$0.88

Service Code	HCPCS J1885
Hospital Charge Code	105927498
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of AZ Commercial	$0.79
Rate for Payer: Bisbee Police All Plans	$0.23
Rate for Payer: Cash Price	$0.70
Rate for Payer: Self Pay Self Pay	$0.70

ketorolac 60 mg Inj Sol [CQCH]

Facility

OP

$0.91

Service Code	HCPCS J1885
Hospital Charge Code	105927571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of AZ Commercial	$0.82
Rate for Payer: Aetna of AZ Medicare	$0.25
Rate for Payer: AHCCCS Medicaid	$1.12
Rate for Payer: Allwell Medicaid	$1.12
Rate for Payer: Allwell Medicare	$0.14
Rate for Payer: Amerigroup Medicare	$0.14
Rate for Payer: APIPA Medicare/Medicaid	$0.34
Rate for Payer: AZCH Complete Medicaid	$1.12
Rate for Payer: AZCH Complete Medicare	$0.14
Rate for Payer: Banner UC Health Medicaid	$1.12
Rate for Payer: Banner UC Health Medicare	$0.14
Rate for Payer: Bisbee Police All Plans	$0.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.62
Rate for Payer: Cash Price	$0.73
Rate for Payer: Cash Price	$0.73
Rate for Payer: Cigna of AZ Commercial	$0.59
Rate for Payer: Copperpoint Commercial	$0.23
Rate for Payer: Health Net of AZ Commercial	$0.55
Rate for Payer: Health Net of AZ Medicare	$0.25
Rate for Payer: Humana of AZ Medicare	$0.14
Rate for Payer: Mercy Care Medicaid	$1.12
Rate for Payer: Self Pay Self Pay	$0.73
Rate for Payer: TriWest Medicare	$0.14
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.16

ketorolac 60 mg Inj Sol [CQCH]

Facility

IP

$0.91

Service Code	HCPCS J1885
Hospital Charge Code	105927571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of AZ Commercial	$0.82
Rate for Payer: Bisbee Police All Plans	$0.24
Rate for Payer: Cash Price	$0.73
Rate for Payer: Self Pay Self Pay	$0.73

Kidney And Urinary Tract Infections

Facility

IP

$5,325.73

Service Code	APR-DRG 4633
Hospital Charge Code	APRDRG4631
Min. Negotiated Rate	$5,325.73
Max. Negotiated Rate	$5,325.73
Rate for Payer: AHCCCS Medicaid	$5,325.73
Rate for Payer: Allwell Medicaid	$5,325.73
Rate for Payer: AZCH Complete Medicaid	$5,325.73
Rate for Payer: Banner UC Health Medicaid	$5,325.73
Rate for Payer: Mercy Care Medicaid	$5,325.73

Kidney And Urinary Tract Infections

Facility

IP

$9,414.89

Service Code	APR-DRG 4634
Hospital Charge Code	APRDRG4633
Min. Negotiated Rate	$9,414.89
Max. Negotiated Rate	$9,414.89
Rate for Payer: AHCCCS Medicaid	$9,414.89
Rate for Payer: Allwell Medicaid	$9,414.89
Rate for Payer: AZCH Complete Medicaid	$9,414.89
Rate for Payer: Banner UC Health Medicaid	$9,414.89
Rate for Payer: Mercy Care Medicaid	$9,414.89

Kidney And Urinary Tract Infections

Facility

IP

$3,173.84

Service Code	APR-DRG 4631
Hospital Charge Code	APRDRG4634
Min. Negotiated Rate	$3,173.84
Max. Negotiated Rate	$3,173.84
Rate for Payer: AHCCCS Medicaid	$3,173.84
Rate for Payer: Allwell Medicaid	$3,173.84
Rate for Payer: AZCH Complete Medicaid	$3,173.84
Rate for Payer: Banner UC Health Medicaid	$3,173.84
Rate for Payer: Mercy Care Medicaid	$3,173.84

Kidney And Urinary Tract Infections

Facility

IP

$9,414.89

Service Code	APR-DRG 4634
Hospital Charge Code	APRDRG4634
Min. Negotiated Rate	$9,414.89
Max. Negotiated Rate	$9,414.89
Rate for Payer: AHCCCS Medicaid	$9,414.89
Rate for Payer: Allwell Medicaid	$9,414.89
Rate for Payer: AZCH Complete Medicaid	$9,414.89
Rate for Payer: Banner UC Health Medicaid	$9,414.89
Rate for Payer: Mercy Care Medicaid	$9,414.89

Kidney And Urinary Tract Infections

Facility

IP

$9,414.89

Service Code	APR-DRG 4634
Hospital Charge Code	APRDRG4632
Min. Negotiated Rate	$9,414.89
Max. Negotiated Rate	$9,414.89
Rate for Payer: AHCCCS Medicaid	$9,414.89
Rate for Payer: Allwell Medicaid	$9,414.89
Rate for Payer: AZCH Complete Medicaid	$9,414.89
Rate for Payer: Banner UC Health Medicaid	$9,414.89
Rate for Payer: Mercy Care Medicaid	$9,414.89

Kidney And Urinary Tract Infections

Facility

IP

$5,325.73

Service Code	APR-DRG 4633
Hospital Charge Code	APRDRG4633
Min. Negotiated Rate	$5,325.73
Max. Negotiated Rate	$5,325.73
Rate for Payer: AHCCCS Medicaid	$5,325.73
Rate for Payer: Allwell Medicaid	$5,325.73
Rate for Payer: AZCH Complete Medicaid	$5,325.73
Rate for Payer: Banner UC Health Medicaid	$5,325.73
Rate for Payer: Mercy Care Medicaid	$5,325.73

Kidney And Urinary Tract Infections

Facility

IP

$3,173.84

Service Code	APR-DRG 4631
Hospital Charge Code	APRDRG4631
Min. Negotiated Rate	$3,173.84
Max. Negotiated Rate	$3,173.84
Rate for Payer: AHCCCS Medicaid	$3,173.84
Rate for Payer: Allwell Medicaid	$3,173.84
Rate for Payer: AZCH Complete Medicaid	$3,173.84
Rate for Payer: Banner UC Health Medicaid	$3,173.84
Rate for Payer: Mercy Care Medicaid	$3,173.84

Kidney And Urinary Tract Infections

Facility

IP

$5,325.73

Service Code	APR-DRG 4633
Hospital Charge Code	APRDRG4634
Min. Negotiated Rate	$5,325.73
Max. Negotiated Rate	$5,325.73
Rate for Payer: AHCCCS Medicaid	$5,325.73
Rate for Payer: Allwell Medicaid	$5,325.73
Rate for Payer: AZCH Complete Medicaid	$5,325.73
Rate for Payer: Banner UC Health Medicaid	$5,325.73
Rate for Payer: Mercy Care Medicaid	$5,325.73

Kidney And Urinary Tract Infections

Facility

IP

$3,863.31

Service Code	APR-DRG 4632
Hospital Charge Code	APRDRG4634
Min. Negotiated Rate	$3,863.31
Max. Negotiated Rate	$3,863.31
Rate for Payer: AHCCCS Medicaid	$3,863.31
Rate for Payer: Allwell Medicaid	$3,863.31
Rate for Payer: AZCH Complete Medicaid	$3,863.31
Rate for Payer: Banner UC Health Medicaid	$3,863.31
Rate for Payer: Mercy Care Medicaid	$3,863.31

Kidney And Urinary Tract Infections

Facility

IP

$3,863.31

Service Code	APR-DRG 4632
Hospital Charge Code	APRDRG4633
Min. Negotiated Rate	$3,863.31
Max. Negotiated Rate	$3,863.31
Rate for Payer: AHCCCS Medicaid	$3,863.31
Rate for Payer: Allwell Medicaid	$3,863.31
Rate for Payer: AZCH Complete Medicaid	$3,863.31
Rate for Payer: Banner UC Health Medicaid	$3,863.31
Rate for Payer: Mercy Care Medicaid	$3,863.31

Kidney And Urinary Tract Infections

Facility

IP

$3,863.31

Service Code	APR-DRG 4632
Hospital Charge Code	APRDRG4631
Min. Negotiated Rate	$3,863.31
Max. Negotiated Rate	$3,863.31
Rate for Payer: AHCCCS Medicaid	$3,863.31
Rate for Payer: Allwell Medicaid	$3,863.31
Rate for Payer: AZCH Complete Medicaid	$3,863.31
Rate for Payer: Banner UC Health Medicaid	$3,863.31
Rate for Payer: Mercy Care Medicaid	$3,863.31

Kidney And Urinary Tract Infections

Facility

IP

$9,414.89

Service Code	APR-DRG 4634
Hospital Charge Code	APRDRG4631
Min. Negotiated Rate	$9,414.89
Max. Negotiated Rate	$9,414.89
Rate for Payer: AHCCCS Medicaid	$9,414.89
Rate for Payer: Allwell Medicaid	$9,414.89
Rate for Payer: AZCH Complete Medicaid	$9,414.89
Rate for Payer: Banner UC Health Medicaid	$9,414.89
Rate for Payer: Mercy Care Medicaid	$9,414.89

Kidney And Urinary Tract Infections

Facility

IP

$3,173.84

Service Code	APR-DRG 4631
Hospital Charge Code	APRDRG4632
Min. Negotiated Rate	$3,173.84
Max. Negotiated Rate	$3,173.84
Rate for Payer: AHCCCS Medicaid	$3,173.84
Rate for Payer: Allwell Medicaid	$3,173.84
Rate for Payer: AZCH Complete Medicaid	$3,173.84
Rate for Payer: Banner UC Health Medicaid	$3,173.84
Rate for Payer: Mercy Care Medicaid	$3,173.84

Kidney And Urinary Tract Infections

Facility

IP

$5,325.73

Service Code	APR-DRG 4633
Hospital Charge Code	APRDRG4632
Min. Negotiated Rate	$5,325.73
Max. Negotiated Rate	$5,325.73
Rate for Payer: AHCCCS Medicaid	$5,325.73
Rate for Payer: Allwell Medicaid	$5,325.73
Rate for Payer: AZCH Complete Medicaid	$5,325.73
Rate for Payer: Banner UC Health Medicaid	$5,325.73
Rate for Payer: Mercy Care Medicaid	$5,325.73

Kidney And Urinary Tract Infections

Facility

IP

$3,863.31

Service Code	APR-DRG 4632
Hospital Charge Code	APRDRG4632
Min. Negotiated Rate	$3,863.31
Max. Negotiated Rate	$3,863.31
Rate for Payer: AHCCCS Medicaid	$3,863.31
Rate for Payer: Allwell Medicaid	$3,863.31
Rate for Payer: AZCH Complete Medicaid	$3,863.31
Rate for Payer: Banner UC Health Medicaid	$3,863.31
Rate for Payer: Mercy Care Medicaid	$3,863.31

Kidney And Urinary Tract Infections

Facility

IP

$3,173.84

Service Code	APR-DRG 4631
Hospital Charge Code	APRDRG4633
Min. Negotiated Rate	$3,173.84
Max. Negotiated Rate	$3,173.84
Rate for Payer: AHCCCS Medicaid	$3,173.84
Rate for Payer: Allwell Medicaid	$3,173.84
Rate for Payer: AZCH Complete Medicaid	$3,173.84
Rate for Payer: Banner UC Health Medicaid	$3,173.84
Rate for Payer: Mercy Care Medicaid	$3,173.84

Kidney And Urinary Tract Malignancy

Facility

IP

$13,346.94

Service Code	APR-DRG 4614
Hospital Charge Code	APRDRG4614
Min. Negotiated Rate	$13,346.94
Max. Negotiated Rate	$13,346.94
Rate for Payer: AHCCCS Medicaid	$13,346.94
Rate for Payer: Allwell Medicaid	$13,346.94
Rate for Payer: AZCH Complete Medicaid	$13,346.94
Rate for Payer: Banner UC Health Medicaid	$13,346.94
Rate for Payer: Mercy Care Medicaid	$13,346.94

Kidney And Urinary Tract Malignancy

Facility

IP

$5,059.20

Service Code	APR-DRG 4611
Hospital Charge Code	APRDRG4611
Min. Negotiated Rate	$5,059.20
Max. Negotiated Rate	$5,059.20
Rate for Payer: AHCCCS Medicaid	$5,059.20
Rate for Payer: Allwell Medicaid	$5,059.20
Rate for Payer: AZCH Complete Medicaid	$5,059.20
Rate for Payer: Banner UC Health Medicaid	$5,059.20
Rate for Payer: Mercy Care Medicaid	$5,059.20

Kidney And Urinary Tract Malignancy

Facility

IP

$13,346.94

Service Code	APR-DRG 4614
Hospital Charge Code	APRDRG4612
Min. Negotiated Rate	$13,346.94
Max. Negotiated Rate	$13,346.94
Rate for Payer: AHCCCS Medicaid	$13,346.94
Rate for Payer: Allwell Medicaid	$13,346.94
Rate for Payer: AZCH Complete Medicaid	$13,346.94
Rate for Payer: Banner UC Health Medicaid	$13,346.94
Rate for Payer: Mercy Care Medicaid	$13,346.94

Kidney And Urinary Tract Malignancy

Facility

IP

$5,549.48

Service Code	APR-DRG 4612
Hospital Charge Code	APRDRG4611
Min. Negotiated Rate	$5,549.48
Max. Negotiated Rate	$5,549.48
Rate for Payer: AHCCCS Medicaid	$5,549.48
Rate for Payer: Allwell Medicaid	$5,549.48
Rate for Payer: AZCH Complete Medicaid	$5,549.48
Rate for Payer: Banner UC Health Medicaid	$5,549.48
Rate for Payer: Mercy Care Medicaid	$5,549.48

Kidney And Urinary Tract Malignancy

Facility

IP

$8,553.57

Service Code	APR-DRG 4613
Hospital Charge Code	APRDRG4612
Min. Negotiated Rate	$8,553.57
Max. Negotiated Rate	$8,553.57
Rate for Payer: AHCCCS Medicaid	$8,553.57
Rate for Payer: Allwell Medicaid	$8,553.57
Rate for Payer: AZCH Complete Medicaid	$8,553.57
Rate for Payer: Banner UC Health Medicaid	$8,553.57
Rate for Payer: Mercy Care Medicaid	$8,553.57

Kidney And Urinary Tract Malignancy

Facility

IP

$5,059.20

Service Code	APR-DRG 4611
Hospital Charge Code	APRDRG4612
Min. Negotiated Rate	$5,059.20
Max. Negotiated Rate	$5,059.20
Rate for Payer: AHCCCS Medicaid	$5,059.20
Rate for Payer: Allwell Medicaid	$5,059.20
Rate for Payer: AZCH Complete Medicaid	$5,059.20
Rate for Payer: Banner UC Health Medicaid	$5,059.20
Rate for Payer: Mercy Care Medicaid	$5,059.20

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