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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Non-Hypovolemic Sodium Disorders

Facility

IP

$12,041.64

Service Code	APR-DRG 4264
Hospital Charge Code	APRDRG4262
Min. Negotiated Rate	$12,041.64
Max. Negotiated Rate	$12,041.64
Rate for Payer: AHCCCS Medicaid	$12,041.64
Rate for Payer: Allwell Medicaid	$12,041.64
Rate for Payer: AZCH Complete Medicaid	$12,041.64
Rate for Payer: Banner UC Health Medicaid	$12,041.64
Rate for Payer: Mercy Care Medicaid	$12,041.64

Non-Hypovolemic Sodium Disorders

Facility

IP

$12,041.64

Service Code	APR-DRG 4264
Hospital Charge Code	APRDRG4263
Min. Negotiated Rate	$12,041.64
Max. Negotiated Rate	$12,041.64
Rate for Payer: AHCCCS Medicaid	$12,041.64
Rate for Payer: Allwell Medicaid	$12,041.64
Rate for Payer: AZCH Complete Medicaid	$12,041.64
Rate for Payer: Banner UC Health Medicaid	$12,041.64
Rate for Payer: Mercy Care Medicaid	$12,041.64

Non-Hypovolemic Sodium Disorders

Facility

IP

$12,041.64

Service Code	APR-DRG 4264
Hospital Charge Code	APRDRG4264
Min. Negotiated Rate	$12,041.64
Max. Negotiated Rate	$12,041.64
Rate for Payer: AHCCCS Medicaid	$12,041.64
Rate for Payer: Allwell Medicaid	$12,041.64
Rate for Payer: AZCH Complete Medicaid	$12,041.64
Rate for Payer: Banner UC Health Medicaid	$12,041.64
Rate for Payer: Mercy Care Medicaid	$12,041.64

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$7,488.15

Service Code	APR-DRG 0463
Hospital Charge Code	APRDRG0462
Min. Negotiated Rate	$7,488.15
Max. Negotiated Rate	$7,488.15
Rate for Payer: AHCCCS Medicaid	$7,488.15
Rate for Payer: Allwell Medicaid	$7,488.15
Rate for Payer: AZCH Complete Medicaid	$7,488.15
Rate for Payer: Banner UC Health Medicaid	$7,488.15
Rate for Payer: Mercy Care Medicaid	$7,488.15

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$5,677.83

Service Code	APR-DRG 0462
Hospital Charge Code	APRDRG0461
Min. Negotiated Rate	$5,677.83
Max. Negotiated Rate	$5,677.83
Rate for Payer: AHCCCS Medicaid	$5,677.83
Rate for Payer: Allwell Medicaid	$5,677.83
Rate for Payer: AZCH Complete Medicaid	$5,677.83
Rate for Payer: Banner UC Health Medicaid	$5,677.83
Rate for Payer: Mercy Care Medicaid	$5,677.83

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$13,441.63

Service Code	APR-DRG 0464
Hospital Charge Code	APRDRG0463
Min. Negotiated Rate	$13,441.63
Max. Negotiated Rate	$13,441.63
Rate for Payer: AHCCCS Medicaid	$13,441.63
Rate for Payer: Allwell Medicaid	$13,441.63
Rate for Payer: AZCH Complete Medicaid	$13,441.63
Rate for Payer: Banner UC Health Medicaid	$13,441.63
Rate for Payer: Mercy Care Medicaid	$13,441.63

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$4,874.03

Service Code	APR-DRG 0461
Hospital Charge Code	APRDRG0461
Min. Negotiated Rate	$4,874.03
Max. Negotiated Rate	$4,874.03
Rate for Payer: AHCCCS Medicaid	$4,874.03
Rate for Payer: Allwell Medicaid	$4,874.03
Rate for Payer: AZCH Complete Medicaid	$4,874.03
Rate for Payer: Banner UC Health Medicaid	$4,874.03
Rate for Payer: Mercy Care Medicaid	$4,874.03

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$13,441.63

Service Code	APR-DRG 0464
Hospital Charge Code	APRDRG0464
Min. Negotiated Rate	$13,441.63
Max. Negotiated Rate	$13,441.63
Rate for Payer: AHCCCS Medicaid	$13,441.63
Rate for Payer: Allwell Medicaid	$13,441.63
Rate for Payer: AZCH Complete Medicaid	$13,441.63
Rate for Payer: Banner UC Health Medicaid	$13,441.63
Rate for Payer: Mercy Care Medicaid	$13,441.63

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$7,488.15

Service Code	APR-DRG 0463
Hospital Charge Code	APRDRG0464
Min. Negotiated Rate	$7,488.15
Max. Negotiated Rate	$7,488.15
Rate for Payer: AHCCCS Medicaid	$7,488.15
Rate for Payer: Allwell Medicaid	$7,488.15
Rate for Payer: AZCH Complete Medicaid	$7,488.15
Rate for Payer: Banner UC Health Medicaid	$7,488.15
Rate for Payer: Mercy Care Medicaid	$7,488.15

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$13,441.63

Service Code	APR-DRG 0464
Hospital Charge Code	APRDRG0462
Min. Negotiated Rate	$13,441.63
Max. Negotiated Rate	$13,441.63
Rate for Payer: AHCCCS Medicaid	$13,441.63
Rate for Payer: Allwell Medicaid	$13,441.63
Rate for Payer: AZCH Complete Medicaid	$13,441.63
Rate for Payer: Banner UC Health Medicaid	$13,441.63
Rate for Payer: Mercy Care Medicaid	$13,441.63

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$5,677.83

Service Code	APR-DRG 0462
Hospital Charge Code	APRDRG0464
Min. Negotiated Rate	$5,677.83
Max. Negotiated Rate	$5,677.83
Rate for Payer: AHCCCS Medicaid	$5,677.83
Rate for Payer: Allwell Medicaid	$5,677.83
Rate for Payer: AZCH Complete Medicaid	$5,677.83
Rate for Payer: Banner UC Health Medicaid	$5,677.83
Rate for Payer: Mercy Care Medicaid	$5,677.83

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$5,677.83

Service Code	APR-DRG 0462
Hospital Charge Code	APRDRG0463
Min. Negotiated Rate	$5,677.83
Max. Negotiated Rate	$5,677.83
Rate for Payer: AHCCCS Medicaid	$5,677.83
Rate for Payer: Allwell Medicaid	$5,677.83
Rate for Payer: AZCH Complete Medicaid	$5,677.83
Rate for Payer: Banner UC Health Medicaid	$5,677.83
Rate for Payer: Mercy Care Medicaid	$5,677.83

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$4,874.03

Service Code	APR-DRG 0461
Hospital Charge Code	APRDRG0464
Min. Negotiated Rate	$4,874.03
Max. Negotiated Rate	$4,874.03
Rate for Payer: AHCCCS Medicaid	$4,874.03
Rate for Payer: Allwell Medicaid	$4,874.03
Rate for Payer: AZCH Complete Medicaid	$4,874.03
Rate for Payer: Banner UC Health Medicaid	$4,874.03
Rate for Payer: Mercy Care Medicaid	$4,874.03

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$7,488.15

Service Code	APR-DRG 0463
Hospital Charge Code	APRDRG0463
Min. Negotiated Rate	$7,488.15
Max. Negotiated Rate	$7,488.15
Rate for Payer: AHCCCS Medicaid	$7,488.15
Rate for Payer: Allwell Medicaid	$7,488.15
Rate for Payer: AZCH Complete Medicaid	$7,488.15
Rate for Payer: Banner UC Health Medicaid	$7,488.15
Rate for Payer: Mercy Care Medicaid	$7,488.15

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$4,874.03

Service Code	APR-DRG 0461
Hospital Charge Code	APRDRG0462
Min. Negotiated Rate	$4,874.03
Max. Negotiated Rate	$4,874.03
Rate for Payer: AHCCCS Medicaid	$4,874.03
Rate for Payer: Allwell Medicaid	$4,874.03
Rate for Payer: AZCH Complete Medicaid	$4,874.03
Rate for Payer: Banner UC Health Medicaid	$4,874.03
Rate for Payer: Mercy Care Medicaid	$4,874.03

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$5,677.83

Service Code	APR-DRG 0462
Hospital Charge Code	APRDRG0462
Min. Negotiated Rate	$5,677.83
Max. Negotiated Rate	$5,677.83
Rate for Payer: AHCCCS Medicaid	$5,677.83
Rate for Payer: Allwell Medicaid	$5,677.83
Rate for Payer: AZCH Complete Medicaid	$5,677.83
Rate for Payer: Banner UC Health Medicaid	$5,677.83
Rate for Payer: Mercy Care Medicaid	$5,677.83

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$4,874.03

Service Code	APR-DRG 0461
Hospital Charge Code	APRDRG0463
Min. Negotiated Rate	$4,874.03
Max. Negotiated Rate	$4,874.03
Rate for Payer: AHCCCS Medicaid	$4,874.03
Rate for Payer: Allwell Medicaid	$4,874.03
Rate for Payer: AZCH Complete Medicaid	$4,874.03
Rate for Payer: Banner UC Health Medicaid	$4,874.03
Rate for Payer: Mercy Care Medicaid	$4,874.03

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$7,488.15

Service Code	APR-DRG 0463
Hospital Charge Code	APRDRG0461
Min. Negotiated Rate	$7,488.15
Max. Negotiated Rate	$7,488.15
Rate for Payer: AHCCCS Medicaid	$7,488.15
Rate for Payer: Allwell Medicaid	$7,488.15
Rate for Payer: AZCH Complete Medicaid	$7,488.15
Rate for Payer: Banner UC Health Medicaid	$7,488.15
Rate for Payer: Mercy Care Medicaid	$7,488.15

Nonspecific Cva And Precerebral Occlusion Without Infarction

Facility

IP

$13,441.63

Service Code	APR-DRG 0464
Hospital Charge Code	APRDRG0461
Min. Negotiated Rate	$13,441.63
Max. Negotiated Rate	$13,441.63
Rate for Payer: AHCCCS Medicaid	$13,441.63
Rate for Payer: Allwell Medicaid	$13,441.63
Rate for Payer: AZCH Complete Medicaid	$13,441.63
Rate for Payer: Banner UC Health Medicaid	$13,441.63
Rate for Payer: Mercy Care Medicaid	$13,441.63

norEPINEPHrine 4 mg/250 mL-D5% Sol[CQCH]

Facility

IP

$0.07

Service Code	NDC 338011220
Hospital Charge Code	238057883
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

norEPINEPHrine 4 mg/250 mL-D5% Sol[CQCH]

Facility

OP

$0.07

Service Code	NDC 338011220
Hospital Charge Code	238057883
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Aetna of AZ Commercial	$0.06
Rate for Payer: Aetna of AZ Medicare	$0.02
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.05
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.04
Rate for Payer: Health Net of AZ Medicare	$0.02
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.06
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

norEPINEPHrine 4 mg/ 4 mL IV Sol [CQCH]

Facility

OP

$1.55

Service Code	NDC 703115303
Hospital Charge Code	105934341
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Aetna of AZ Medicare	$0.43
Rate for Payer: Allwell Medicare	$0.25
Rate for Payer: Amerigroup Medicare	$0.25
Rate for Payer: APIPA Medicare/Medicaid	$0.58
Rate for Payer: AZCH Complete Medicare	$0.25
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Bisbee Police All Plans	$0.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.05
Rate for Payer: Cash Price	$1.24
Rate for Payer: Cigna of AZ Commercial	$1.01
Rate for Payer: Copperpoint Commercial	$0.38
Rate for Payer: Health Net of AZ Commercial	$0.93
Rate for Payer: Health Net of AZ Medicare	$0.43
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Self Pay Self Pay	$1.24
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.28

norEPINEPHrine 4 mg/ 4 mL IV Sol [CQCH]

Facility

IP

$1.55

Service Code	NDC 703115303
Hospital Charge Code	105934341
Hospital Revenue Code	251
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of AZ Commercial	$1.40
Rate for Payer: Bisbee Police All Plans	$0.40
Rate for Payer: Cash Price	$1.24
Rate for Payer: Self Pay Self Pay	$1.24

NOVACOR 1.5X2.75

Facility

OP

$4,875.00

Hospital Charge Code	27690539
Hospital Revenue Code	270
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$4,387.50
Rate for Payer: Aetna of AZ Commercial	$4,387.50
Rate for Payer: Aetna of AZ Medicare	$1,365.00
Rate for Payer: Allwell Medicare	$780.00
Rate for Payer: Amerigroup Medicare	$780.00
Rate for Payer: APIPA Medicare/Medicaid	$1,820.81
Rate for Payer: AZCH Complete Medicare	$780.00
Rate for Payer: Banner UC Health Medicare	$780.00
Rate for Payer: Bisbee Police All Plans	$1,267.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,315.00
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Cigna of AZ Commercial	$3,412.50
Rate for Payer: Copperpoint Commercial	$1,206.56
Rate for Payer: Health Net of AZ Commercial	$2,925.00
Rate for Payer: Health Net of AZ Medicare	$1,365.00
Rate for Payer: Humana of AZ Medicare	$780.00
Rate for Payer: Self Pay Self Pay	$3,900.00
Rate for Payer: TriWest Medicare	$780.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,842.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$877.50

NOVACOR 1.5X2.75

Facility

IP

$4,875.00

Hospital Charge Code	27690539
Hospital Revenue Code	270
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$4,387.50
Rate for Payer: Aetna of AZ Commercial	$4,387.50
Rate for Payer: Bisbee Police All Plans	$1,267.50
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Self Pay Self Pay	$3,900.00

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