Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior

Facility

IP

$4,371.12

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG6942
Min. Negotiated Rate	$4,371.12
Max. Negotiated Rate	$4,371.12
Rate for Payer: AHCCCS Medicaid	$4,371.12
Rate for Payer: Allwell Medicaid	$4,371.12
Rate for Payer: AZCH Complete Medicaid	$4,371.12
Rate for Payer: Banner UC Health Medicaid	$4,371.12
Rate for Payer: Mercy Care Medicaid	$4,371.12

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$13,707.46

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$13,707.46
Max. Negotiated Rate	$13,707.46
Rate for Payer: AHCCCS Medicaid	$13,707.46
Rate for Payer: Allwell Medicaid	$13,707.46
Rate for Payer: AZCH Complete Medicaid	$13,707.46
Rate for Payer: Banner UC Health Medicaid	$13,707.46
Rate for Payer: Mercy Care Medicaid	$13,707.46

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: AHCCCS Medicaid	$28,128.24
Rate for Payer: Allwell Medicaid	$28,128.24
Rate for Payer: AZCH Complete Medicaid	$28,128.24
Rate for Payer: Banner UC Health Medicaid	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6914
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6911
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6914
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6911
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$13,707.46

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG6911
Min. Negotiated Rate	$13,707.46
Max. Negotiated Rate	$13,707.46
Rate for Payer: AHCCCS Medicaid	$13,707.46
Rate for Payer: Allwell Medicaid	$13,707.46
Rate for Payer: AZCH Complete Medicaid	$13,707.46
Rate for Payer: Banner UC Health Medicaid	$13,707.46
Rate for Payer: Mercy Care Medicaid	$13,707.46

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$13,707.46

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$13,707.46
Max. Negotiated Rate	$13,707.46
Rate for Payer: AHCCCS Medicaid	$13,707.46
Rate for Payer: Allwell Medicaid	$13,707.46
Rate for Payer: AZCH Complete Medicaid	$13,707.46
Rate for Payer: Banner UC Health Medicaid	$13,707.46
Rate for Payer: Mercy Care Medicaid	$13,707.46

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$8,613.89

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$8,613.89
Max. Negotiated Rate	$8,613.89
Rate for Payer: AHCCCS Medicaid	$8,613.89
Rate for Payer: Allwell Medicaid	$8,613.89
Rate for Payer: AZCH Complete Medicaid	$8,613.89
Rate for Payer: Banner UC Health Medicaid	$8,613.89
Rate for Payer: Mercy Care Medicaid	$8,613.89

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6913
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$13,707.46

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG6914
Min. Negotiated Rate	$13,707.46
Max. Negotiated Rate	$13,707.46
Rate for Payer: AHCCCS Medicaid	$13,707.46
Rate for Payer: Allwell Medicaid	$13,707.46
Rate for Payer: AZCH Complete Medicaid	$13,707.46
Rate for Payer: Banner UC Health Medicaid	$13,707.46
Rate for Payer: Mercy Care Medicaid	$13,707.46

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$6,844.96

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$6,844.96
Max. Negotiated Rate	$6,844.96
Rate for Payer: AHCCCS Medicaid	$6,844.96
Rate for Payer: Allwell Medicaid	$6,844.96
Rate for Payer: AZCH Complete Medicaid	$6,844.96
Rate for Payer: Banner UC Health Medicaid	$6,844.96
Rate for Payer: Mercy Care Medicaid	$6,844.96

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6911
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: AHCCCS Medicaid	$28,128.24
Rate for Payer: Allwell Medicaid	$28,128.24
Rate for Payer: AZCH Complete Medicaid	$28,128.24
Rate for Payer: Banner UC Health Medicaid	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6914
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: AHCCCS Medicaid	$28,128.24
Rate for Payer: Allwell Medicaid	$28,128.24
Rate for Payer: AZCH Complete Medicaid	$28,128.24
Rate for Payer: Banner UC Health Medicaid	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24

Lymphoma, Myeloma And Non-Acute Leukemia

Facility

IP

$28,128.24

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG6912
Min. Negotiated Rate	$28,128.24
Max. Negotiated Rate	$28,128.24
Rate for Payer: AHCCCS Medicaid	$28,128.24
Rate for Payer: Allwell Medicaid	$28,128.24
Rate for Payer: AZCH Complete Medicaid	$28,128.24
Rate for Payer: Banner UC Health Medicaid	$28,128.24
Rate for Payer: Mercy Care Medicaid	$28,128.24

Lysis of adhesions

Facility

OP

$5,933.00

Service Code	CPT 44005
Hospital Charge Code	27267811
Hospital Revenue Code	360
Min. Negotiated Rate	$949.28
Max. Negotiated Rate	$5,339.70
Rate for Payer: Aetna of AZ Commercial	$5,339.70
Rate for Payer: Aetna of AZ Medicare	$1,661.24
Rate for Payer: Allwell Medicare	$949.28
Rate for Payer: Amerigroup Medicare	$949.28
Rate for Payer: APIPA Medicare/Medicaid	$2,215.98
Rate for Payer: AZCH Complete Medicare	$949.28
Rate for Payer: Banner UC Health Medicare	$949.28
Rate for Payer: Bisbee Police All Plans	$1,542.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,034.44
Rate for Payer: Cash Price	$4,746.40
Rate for Payer: Cash Price	$4,746.40
Rate for Payer: Cigna of AZ Commercial	$2,966.50
Rate for Payer: Copperpoint Commercial	$1,468.42
Rate for Payer: Health Net of AZ Commercial	$3,559.80
Rate for Payer: Health Net of AZ Medicare	$1,661.24
Rate for Payer: Humana of AZ Medicare	$949.28
Rate for Payer: Self Pay Self Pay	$4,746.40
Rate for Payer: TriWest Medicare	$949.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,067.94

Lysis of adhesions

Facility

IP

$5,933.00

Service Code	CPT 44005
Hospital Charge Code	27267811
Hospital Revenue Code	360
Min. Negotiated Rate	$1,542.58
Max. Negotiated Rate	$5,339.70
Rate for Payer: Aetna of AZ Commercial	$5,339.70
Rate for Payer: Bisbee Police All Plans	$1,542.58
Rate for Payer: Cash Price	$4,746.40
Rate for Payer: Self Pay Self Pay	$4,746.40

M005-IgE Candida albicans LC

Facility

IP

$64.00

Service Code	CPT 86003
Hospital Charge Code	22311199
Hospital Revenue Code	302
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Cash Price	$51.20
Rate for Payer: Self Pay Self Pay	$51.20

M005-IgE Candida albicans LC

Facility

OP

$64.00

Service Code	CPT 86003
Hospital Charge Code	22311199
Hospital Revenue Code	302
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Aetna of AZ Medicare	$17.92
Rate for Payer: Allwell Medicare	$10.24
Rate for Payer: Amerigroup Medicare	$10.24
Rate for Payer: APIPA Medicare/Medicaid	$23.90
Rate for Payer: AZCH Complete Medicare	$10.24
Rate for Payer: Banner UC Health Medicare	$10.24
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.52
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$41.60
Rate for Payer: Copperpoint Commercial	$15.84
Rate for Payer: Health Net of AZ Commercial	$38.40
Rate for Payer: Health Net of AZ Medicare	$17.92
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Self Pay Self Pay	$51.20
Rate for Payer: TriWest Medicare	$10.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.52

Maalox 200 mg-200 mg-20 mg/5 mL Sus UD[CQCH]

Facility

OP

$0.19

Service Code	NDC 57237031631
Hospital Charge Code	239216300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Aetna of AZ Medicare	$0.05
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.13
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.11
Rate for Payer: Health Net of AZ Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.15
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

Maalox 200 mg-200 mg-20 mg/5 mL Sus UD[CQCH]

Facility

IP

$0.19

Service Code	NDC 57237031631
Hospital Charge Code	239216300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.15
Rate for Payer: Self Pay Self Pay	$0.15

Maalox-plus XS 30 mL UD [CQCH]

Facility

IP

$0.01

Service Code	NDC 121176230
Hospital Charge Code	105930075
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

Maalox-plus XS 30 mL UD [CQCH]

Facility

OP

$0.01

Service Code	NDC 121176230
Hospital Charge Code	105930075
Hospital Revenue Code	251
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

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