Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Organic Mental Health Disturbances

Facility

IP

$14,824.09

Service Code	APR-DRG 7574
Hospital Charge Code	APRDRG7571
Min. Negotiated Rate	$14,824.09
Max. Negotiated Rate	$14,824.09
Rate for Payer: AHCCCS Medicaid	$14,824.09
Rate for Payer: Allwell Medicaid	$14,824.09
Rate for Payer: AZCH Complete Medicaid	$14,824.09
Rate for Payer: Banner UC Health Medicaid	$14,824.09
Rate for Payer: Mercy Care Medicaid	$14,824.09

Organic Mental Health Disturbances

Facility

IP

$3,070.73

Service Code	APR-DRG 7571
Hospital Charge Code	APRDRG7571
Min. Negotiated Rate	$3,070.73
Max. Negotiated Rate	$3,070.73
Rate for Payer: AHCCCS Medicaid	$3,070.73
Rate for Payer: Allwell Medicaid	$3,070.73
Rate for Payer: AZCH Complete Medicaid	$3,070.73
Rate for Payer: Banner UC Health Medicaid	$3,070.73
Rate for Payer: Mercy Care Medicaid	$3,070.73

Organic Mental Health Disturbances

Facility

IP

$14,824.09

Service Code	APR-DRG 7574
Hospital Charge Code	APRDRG7572
Min. Negotiated Rate	$14,824.09
Max. Negotiated Rate	$14,824.09
Rate for Payer: AHCCCS Medicaid	$14,824.09
Rate for Payer: Allwell Medicaid	$14,824.09
Rate for Payer: AZCH Complete Medicaid	$14,824.09
Rate for Payer: Banner UC Health Medicaid	$14,824.09
Rate for Payer: Mercy Care Medicaid	$14,824.09

Organic Mental Health Disturbances

Facility

IP

$4,086.36

Service Code	APR-DRG 7572
Hospital Charge Code	APRDRG7572
Min. Negotiated Rate	$4,086.36
Max. Negotiated Rate	$4,086.36
Rate for Payer: AHCCCS Medicaid	$4,086.36
Rate for Payer: Allwell Medicaid	$4,086.36
Rate for Payer: AZCH Complete Medicaid	$4,086.36
Rate for Payer: Banner UC Health Medicaid	$4,086.36
Rate for Payer: Mercy Care Medicaid	$4,086.36

Organic Mental Health Disturbances

Facility

IP

$7,742.75

Service Code	APR-DRG 7573
Hospital Charge Code	APRDRG7572
Min. Negotiated Rate	$7,742.75
Max. Negotiated Rate	$7,742.75
Rate for Payer: AHCCCS Medicaid	$7,742.75
Rate for Payer: Allwell Medicaid	$7,742.75
Rate for Payer: AZCH Complete Medicaid	$7,742.75
Rate for Payer: Banner UC Health Medicaid	$7,742.75
Rate for Payer: Mercy Care Medicaid	$7,742.75

Organic Mental Health Disturbances

Facility

IP

$4,086.36

Service Code	APR-DRG 7572
Hospital Charge Code	APRDRG7574
Min. Negotiated Rate	$4,086.36
Max. Negotiated Rate	$4,086.36
Rate for Payer: AHCCCS Medicaid	$4,086.36
Rate for Payer: Allwell Medicaid	$4,086.36
Rate for Payer: AZCH Complete Medicaid	$4,086.36
Rate for Payer: Banner UC Health Medicaid	$4,086.36
Rate for Payer: Mercy Care Medicaid	$4,086.36

Organic Mental Health Disturbances

Facility

IP

$7,742.75

Service Code	APR-DRG 7573
Hospital Charge Code	APRDRG7571
Min. Negotiated Rate	$7,742.75
Max. Negotiated Rate	$7,742.75
Rate for Payer: AHCCCS Medicaid	$7,742.75
Rate for Payer: Allwell Medicaid	$7,742.75
Rate for Payer: AZCH Complete Medicaid	$7,742.75
Rate for Payer: Banner UC Health Medicaid	$7,742.75
Rate for Payer: Mercy Care Medicaid	$7,742.75

Organic Mental Health Disturbances

Facility

IP

$7,742.75

Service Code	APR-DRG 7573
Hospital Charge Code	APRDRG7574
Min. Negotiated Rate	$7,742.75
Max. Negotiated Rate	$7,742.75
Rate for Payer: AHCCCS Medicaid	$7,742.75
Rate for Payer: Allwell Medicaid	$7,742.75
Rate for Payer: AZCH Complete Medicaid	$7,742.75
Rate for Payer: Banner UC Health Medicaid	$7,742.75
Rate for Payer: Mercy Care Medicaid	$7,742.75

Organic Mental Health Disturbances

Facility

IP

$3,070.73

Service Code	APR-DRG 7571
Hospital Charge Code	APRDRG7572
Min. Negotiated Rate	$3,070.73
Max. Negotiated Rate	$3,070.73
Rate for Payer: AHCCCS Medicaid	$3,070.73
Rate for Payer: Allwell Medicaid	$3,070.73
Rate for Payer: AZCH Complete Medicaid	$3,070.73
Rate for Payer: Banner UC Health Medicaid	$3,070.73
Rate for Payer: Mercy Care Medicaid	$3,070.73

Organic Mental Health Disturbances

Facility

IP

$3,070.73

Service Code	APR-DRG 7571
Hospital Charge Code	APRDRG7573
Min. Negotiated Rate	$3,070.73
Max. Negotiated Rate	$3,070.73
Rate for Payer: AHCCCS Medicaid	$3,070.73
Rate for Payer: Allwell Medicaid	$3,070.73
Rate for Payer: AZCH Complete Medicaid	$3,070.73
Rate for Payer: Banner UC Health Medicaid	$3,070.73
Rate for Payer: Mercy Care Medicaid	$3,070.73

Organic Mental Health Disturbances

Facility

IP

$4,086.36

Service Code	APR-DRG 7572
Hospital Charge Code	APRDRG7571
Min. Negotiated Rate	$4,086.36
Max. Negotiated Rate	$4,086.36
Rate for Payer: AHCCCS Medicaid	$4,086.36
Rate for Payer: Allwell Medicaid	$4,086.36
Rate for Payer: AZCH Complete Medicaid	$4,086.36
Rate for Payer: Banner UC Health Medicaid	$4,086.36
Rate for Payer: Mercy Care Medicaid	$4,086.36

Organic Mental Health Disturbances

Facility

IP

$3,070.73

Service Code	APR-DRG 7571
Hospital Charge Code	APRDRG7574
Min. Negotiated Rate	$3,070.73
Max. Negotiated Rate	$3,070.73
Rate for Payer: AHCCCS Medicaid	$3,070.73
Rate for Payer: Allwell Medicaid	$3,070.73
Rate for Payer: AZCH Complete Medicaid	$3,070.73
Rate for Payer: Banner UC Health Medicaid	$3,070.73
Rate for Payer: Mercy Care Medicaid	$3,070.73

Organic Mental Health Disturbances

Facility

IP

$14,824.09

Service Code	APR-DRG 7574
Hospital Charge Code	APRDRG7574
Min. Negotiated Rate	$14,824.09
Max. Negotiated Rate	$14,824.09
Rate for Payer: AHCCCS Medicaid	$14,824.09
Rate for Payer: Allwell Medicaid	$14,824.09
Rate for Payer: AZCH Complete Medicaid	$14,824.09
Rate for Payer: Banner UC Health Medicaid	$14,824.09
Rate for Payer: Mercy Care Medicaid	$14,824.09

Organic Mental Health Disturbances

Facility

IP

$14,824.09

Service Code	APR-DRG 7574
Hospital Charge Code	APRDRG7573
Min. Negotiated Rate	$14,824.09
Max. Negotiated Rate	$14,824.09
Rate for Payer: AHCCCS Medicaid	$14,824.09
Rate for Payer: Allwell Medicaid	$14,824.09
Rate for Payer: AZCH Complete Medicaid	$14,824.09
Rate for Payer: Banner UC Health Medicaid	$14,824.09
Rate for Payer: Mercy Care Medicaid	$14,824.09

ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR

Facility

IP

$803.00

Hospital Charge Code	23697416
Hospital Revenue Code	270
Min. Negotiated Rate	$208.78
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Cash Price	$642.40
Rate for Payer: Self Pay Self Pay	$642.40

ORISE GEL SYRINGE KIT W/INTERJECT NEEDLE 23GA CLEAR

Facility

OP

$803.00

Hospital Charge Code	23697416
Hospital Revenue Code	270
Min. Negotiated Rate	$120.45
Max. Negotiated Rate	$722.70
Rate for Payer: Aetna of AZ Commercial	$722.70
Rate for Payer: Aetna of AZ Medicare	$224.84
Rate for Payer: Allwell Medicare	$120.45
Rate for Payer: Amerigroup Medicare	$120.45
Rate for Payer: APIPA Medicare/Medicaid	$299.92
Rate for Payer: AZCH Complete Medicare	$120.45
Rate for Payer: Banner UC Health Medicare	$120.45
Rate for Payer: Bisbee Police All Plans	$208.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$546.04
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cigna of AZ Commercial	$562.10
Rate for Payer: Copperpoint Commercial	$198.74
Rate for Payer: Health Net of AZ Commercial	$481.80
Rate for Payer: Health Net of AZ Medicare	$224.84
Rate for Payer: Humana of AZ Medicare	$120.45
Rate for Payer: Self Pay Self Pay	$642.40
Rate for Payer: TriWest Medicare	$120.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$468.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.54

orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]

Facility

IP

$7.12

Service Code	HCPCS J2360
Hospital Charge Code	105935017
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$6.41
Rate for Payer: Aetna of AZ Commercial	$6.41
Rate for Payer: Bisbee Police All Plans	$1.85
Rate for Payer: Cash Price	$5.70
Rate for Payer: Self Pay Self Pay	$5.70

orphenadrine 60 mg/ 2 mL Inj Sol [CQCH]

Facility

OP

$7.12

Service Code	HCPCS J2360
Hospital Charge Code	105935017
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$8.16
Rate for Payer: Aetna of AZ Commercial	$6.41
Rate for Payer: Aetna of AZ Medicare	$1.99
Rate for Payer: AHCCCS Medicaid	$8.16
Rate for Payer: Allwell Medicaid	$8.16
Rate for Payer: Allwell Medicare	$1.07
Rate for Payer: Amerigroup Medicare	$1.07
Rate for Payer: APIPA Medicare/Medicaid	$2.66
Rate for Payer: AZCH Complete Medicaid	$8.16
Rate for Payer: AZCH Complete Medicare	$1.07
Rate for Payer: Banner UC Health Medicaid	$8.16
Rate for Payer: Banner UC Health Medicare	$1.07
Rate for Payer: Bisbee Police All Plans	$1.85
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.84
Rate for Payer: Cash Price	$5.70
Rate for Payer: Cash Price	$5.70
Rate for Payer: Cigna of AZ Commercial	$4.63
Rate for Payer: Copperpoint Commercial	$1.76
Rate for Payer: Health Net of AZ Commercial	$4.27
Rate for Payer: Health Net of AZ Medicare	$1.99
Rate for Payer: Humana of AZ Medicare	$1.07
Rate for Payer: Mercy Care Medicaid	$8.16
Rate for Payer: Self Pay Self Pay	$5.70
Rate for Payer: TriWest Medicare	$1.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.28

oseltamivir 75 mg Cap [CQCH]

Facility

IP

$1.73

Service Code	NDC 31722063231
Hospital Charge Code	105935149
Hospital Revenue Code	251
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Cash Price	$1.39
Rate for Payer: Self Pay Self Pay	$1.38

oseltamivir 75 mg Cap [CQCH]

Facility

OP

$1.73

Service Code	NDC 31722063231
Hospital Charge Code	105935149
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Aetna of AZ Medicare	$0.48
Rate for Payer: Allwell Medicare	$0.26
Rate for Payer: Amerigroup Medicare	$0.26
Rate for Payer: APIPA Medicare/Medicaid	$0.65
Rate for Payer: AZCH Complete Medicare	$0.26
Rate for Payer: Banner UC Health Medicare	$0.26
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.18
Rate for Payer: Cash Price	$1.39
Rate for Payer: Cigna of AZ Commercial	$1.12
Rate for Payer: Copperpoint Commercial	$0.43
Rate for Payer: Health Net of AZ Commercial	$1.04
Rate for Payer: Health Net of AZ Medicare	$0.48
Rate for Payer: Humana of AZ Medicare	$0.26
Rate for Payer: Self Pay Self Pay	$1.38
Rate for Payer: TriWest Medicare	$0.26
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.31

oseltamivir oral susp 6 mg/mL -60mL [CQCH]

Facility

IP

$148.46

Service Code	NDC 4082205
Hospital Charge Code	105935088
Hospital Revenue Code	251
Min. Negotiated Rate	$38.60
Max. Negotiated Rate	$133.61
Rate for Payer: Aetna of AZ Commercial	$133.61
Rate for Payer: Bisbee Police All Plans	$38.60
Rate for Payer: Cash Price	$118.77
Rate for Payer: Self Pay Self Pay	$118.77

oseltamivir oral susp 6 mg/mL -60mL [CQCH]

Facility

OP

$148.46

Service Code	NDC 4082205
Hospital Charge Code	105935088
Hospital Revenue Code	251
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$133.61
Rate for Payer: Aetna of AZ Commercial	$133.61
Rate for Payer: Aetna of AZ Medicare	$41.57
Rate for Payer: Allwell Medicare	$22.27
Rate for Payer: Amerigroup Medicare	$22.27
Rate for Payer: APIPA Medicare/Medicaid	$55.45
Rate for Payer: AZCH Complete Medicare	$22.27
Rate for Payer: Banner UC Health Medicare	$22.27
Rate for Payer: Bisbee Police All Plans	$38.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.95
Rate for Payer: Cash Price	$118.77
Rate for Payer: Cigna of AZ Commercial	$96.50
Rate for Payer: Copperpoint Commercial	$36.74
Rate for Payer: Health Net of AZ Commercial	$89.08
Rate for Payer: Health Net of AZ Medicare	$41.57
Rate for Payer: Humana of AZ Medicare	$22.27
Rate for Payer: Self Pay Self Pay	$118.77
Rate for Payer: TriWest Medicare	$22.27
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.72

Osmolality LC

Facility

OP

$186.00

Service Code	CPT 83930
Hospital Charge Code	1287369
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: AHCCCS Medicaid	$6.61
Rate for Payer: Allwell Medicaid	$6.61
Rate for Payer: Allwell Medicare	$27.90
Rate for Payer: Amerigroup Medicare	$27.90
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicaid	$6.61
Rate for Payer: AZCH Complete Medicare	$27.90
Rate for Payer: Banner UC Health Medicaid	$6.61
Rate for Payer: Banner UC Health Medicare	$27.90
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$120.90
Rate for Payer: Copperpoint Commercial	$46.04
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$27.90
Rate for Payer: Mercy Care Medicaid	$6.61
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$27.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

Osmolality LC

Facility

IP

$186.00

Service Code	CPT 83930
Hospital Charge Code	1287369
Hospital Revenue Code	301
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

Osmolality, Serum

Facility

OP

$186.00

Service Code	CPT 83930
Hospital Charge Code	852898
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: AHCCCS Medicaid	$6.61
Rate for Payer: Allwell Medicaid	$6.61
Rate for Payer: Allwell Medicare	$27.90
Rate for Payer: Amerigroup Medicare	$27.90
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicaid	$6.61
Rate for Payer: AZCH Complete Medicare	$27.90
Rate for Payer: Banner UC Health Medicaid	$6.61
Rate for Payer: Banner UC Health Medicare	$27.90
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$120.90
Rate for Payer: Copperpoint Commercial	$46.04
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$27.90
Rate for Payer: Mercy Care Medicaid	$6.61
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$27.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

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