Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SENSOR SPO2 PEDIATRIC NELLCOR

Facility

IP

$46.00

Hospital Charge Code	22546697
Hospital Revenue Code	272
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$41.40
Rate for Payer: Aetna of AZ Commercial	$41.40
Rate for Payer: Bisbee Police All Plans	$11.96
Rate for Payer: Cash Price	$36.80
Rate for Payer: Self Pay Self Pay	$36.80

SENSOR STRAIGHT TIP NITINOL WIRE 035X0150CM

Facility

IP

$418.50

Hospital Charge Code	27975466
Hospital Revenue Code	270
Min. Negotiated Rate	$108.81
Max. Negotiated Rate	$376.65
Rate for Payer: Aetna of AZ Commercial	$376.65
Rate for Payer: Bisbee Police All Plans	$108.81
Rate for Payer: Cash Price	$334.80
Rate for Payer: Self Pay Self Pay	$334.80

SENSOR STRAIGHT TIP NITINOL WIRE 035X0150CM

Facility

OP

$418.50

Hospital Charge Code	27975466
Hospital Revenue Code	270
Min. Negotiated Rate	$66.96
Max. Negotiated Rate	$376.65
Rate for Payer: Aetna of AZ Commercial	$376.65
Rate for Payer: Aetna of AZ Medicare	$117.18
Rate for Payer: Allwell Medicare	$66.96
Rate for Payer: Amerigroup Medicare	$66.96
Rate for Payer: APIPA Medicare/Medicaid	$156.31
Rate for Payer: AZCH Complete Medicare	$66.96
Rate for Payer: Banner UC Health Medicare	$66.96
Rate for Payer: Bisbee Police All Plans	$108.81
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$284.58
Rate for Payer: Cash Price	$334.80
Rate for Payer: Cigna of AZ Commercial	$292.95
Rate for Payer: Copperpoint Commercial	$103.58
Rate for Payer: Health Net of AZ Commercial	$251.10
Rate for Payer: Health Net of AZ Medicare	$117.18
Rate for Payer: Humana of AZ Medicare	$66.96
Rate for Payer: Self Pay Self Pay	$334.80
Rate for Payer: TriWest Medicare	$66.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$243.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.33

Septicemia And Disseminated Infections

Facility

IP

$3,873.13

Service Code	APR-DRG 7201
Hospital Charge Code	APRDRG7202
Min. Negotiated Rate	$3,873.13
Max. Negotiated Rate	$3,873.13
Rate for Payer: AHCCCS Medicaid	$3,873.13
Rate for Payer: Allwell Medicaid	$3,873.13
Rate for Payer: AZCH Complete Medicaid	$3,873.13
Rate for Payer: Banner UC Health Medicaid	$3,873.13
Rate for Payer: Mercy Care Medicaid	$3,873.13

Septicemia And Disseminated Infections

Facility

IP

$4,966.61

Service Code	APR-DRG 7202
Hospital Charge Code	APRDRG7204
Min. Negotiated Rate	$4,966.61
Max. Negotiated Rate	$4,966.61
Rate for Payer: AHCCCS Medicaid	$4,966.61
Rate for Payer: Allwell Medicaid	$4,966.61
Rate for Payer: AZCH Complete Medicaid	$4,966.61
Rate for Payer: Banner UC Health Medicaid	$4,966.61
Rate for Payer: Mercy Care Medicaid	$4,966.61

Septicemia And Disseminated Infections

Facility

IP

$7,570.91

Service Code	APR-DRG 7203
Hospital Charge Code	APRDRG7202
Min. Negotiated Rate	$7,570.91
Max. Negotiated Rate	$7,570.91
Rate for Payer: AHCCCS Medicaid	$7,570.91
Rate for Payer: Allwell Medicaid	$7,570.91
Rate for Payer: AZCH Complete Medicaid	$7,570.91
Rate for Payer: Banner UC Health Medicaid	$7,570.91
Rate for Payer: Mercy Care Medicaid	$7,570.91

Septicemia And Disseminated Infections

Facility

IP

$3,873.13

Service Code	APR-DRG 7201
Hospital Charge Code	APRDRG7201
Min. Negotiated Rate	$3,873.13
Max. Negotiated Rate	$3,873.13
Rate for Payer: AHCCCS Medicaid	$3,873.13
Rate for Payer: Allwell Medicaid	$3,873.13
Rate for Payer: AZCH Complete Medicaid	$3,873.13
Rate for Payer: Banner UC Health Medicaid	$3,873.13
Rate for Payer: Mercy Care Medicaid	$3,873.13

Septicemia And Disseminated Infections

Facility

IP

$7,570.91

Service Code	APR-DRG 7203
Hospital Charge Code	APRDRG7201
Min. Negotiated Rate	$7,570.91
Max. Negotiated Rate	$7,570.91
Rate for Payer: AHCCCS Medicaid	$7,570.91
Rate for Payer: Allwell Medicaid	$7,570.91
Rate for Payer: AZCH Complete Medicaid	$7,570.91
Rate for Payer: Banner UC Health Medicaid	$7,570.91
Rate for Payer: Mercy Care Medicaid	$7,570.91

Septicemia And Disseminated Infections

Facility

IP

$14,811.46

Service Code	APR-DRG 7204
Hospital Charge Code	APRDRG7201
Min. Negotiated Rate	$14,811.46
Max. Negotiated Rate	$14,811.46
Rate for Payer: AHCCCS Medicaid	$14,811.46
Rate for Payer: Allwell Medicaid	$14,811.46
Rate for Payer: AZCH Complete Medicaid	$14,811.46
Rate for Payer: Banner UC Health Medicaid	$14,811.46
Rate for Payer: Mercy Care Medicaid	$14,811.46

Septicemia And Disseminated Infections

Facility

IP

$14,811.46

Service Code	APR-DRG 7204
Hospital Charge Code	APRDRG7202
Min. Negotiated Rate	$14,811.46
Max. Negotiated Rate	$14,811.46
Rate for Payer: AHCCCS Medicaid	$14,811.46
Rate for Payer: Allwell Medicaid	$14,811.46
Rate for Payer: AZCH Complete Medicaid	$14,811.46
Rate for Payer: Banner UC Health Medicaid	$14,811.46
Rate for Payer: Mercy Care Medicaid	$14,811.46

Septicemia And Disseminated Infections

Facility

IP

$14,811.46

Service Code	APR-DRG 7204
Hospital Charge Code	APRDRG7204
Min. Negotiated Rate	$14,811.46
Max. Negotiated Rate	$14,811.46
Rate for Payer: AHCCCS Medicaid	$14,811.46
Rate for Payer: Allwell Medicaid	$14,811.46
Rate for Payer: AZCH Complete Medicaid	$14,811.46
Rate for Payer: Banner UC Health Medicaid	$14,811.46
Rate for Payer: Mercy Care Medicaid	$14,811.46

Septicemia And Disseminated Infections

Facility

IP

$7,570.91

Service Code	APR-DRG 7203
Hospital Charge Code	APRDRG7204
Min. Negotiated Rate	$7,570.91
Max. Negotiated Rate	$7,570.91
Rate for Payer: AHCCCS Medicaid	$7,570.91
Rate for Payer: Allwell Medicaid	$7,570.91
Rate for Payer: AZCH Complete Medicaid	$7,570.91
Rate for Payer: Banner UC Health Medicaid	$7,570.91
Rate for Payer: Mercy Care Medicaid	$7,570.91

Septicemia And Disseminated Infections

Facility

IP

$14,811.46

Service Code	APR-DRG 7204
Hospital Charge Code	APRDRG7203
Min. Negotiated Rate	$14,811.46
Max. Negotiated Rate	$14,811.46
Rate for Payer: AHCCCS Medicaid	$14,811.46
Rate for Payer: Allwell Medicaid	$14,811.46
Rate for Payer: AZCH Complete Medicaid	$14,811.46
Rate for Payer: Banner UC Health Medicaid	$14,811.46
Rate for Payer: Mercy Care Medicaid	$14,811.46

Septicemia And Disseminated Infections

Facility

IP

$3,873.13

Service Code	APR-DRG 7201
Hospital Charge Code	APRDRG7203
Min. Negotiated Rate	$3,873.13
Max. Negotiated Rate	$3,873.13
Rate for Payer: AHCCCS Medicaid	$3,873.13
Rate for Payer: Allwell Medicaid	$3,873.13
Rate for Payer: AZCH Complete Medicaid	$3,873.13
Rate for Payer: Banner UC Health Medicaid	$3,873.13
Rate for Payer: Mercy Care Medicaid	$3,873.13

Septicemia And Disseminated Infections

Facility

IP

$4,966.61

Service Code	APR-DRG 7202
Hospital Charge Code	APRDRG7202
Min. Negotiated Rate	$4,966.61
Max. Negotiated Rate	$4,966.61
Rate for Payer: AHCCCS Medicaid	$4,966.61
Rate for Payer: Allwell Medicaid	$4,966.61
Rate for Payer: AZCH Complete Medicaid	$4,966.61
Rate for Payer: Banner UC Health Medicaid	$4,966.61
Rate for Payer: Mercy Care Medicaid	$4,966.61

Septicemia And Disseminated Infections

Facility

IP

$4,966.61

Service Code	APR-DRG 7202
Hospital Charge Code	APRDRG7201
Min. Negotiated Rate	$4,966.61
Max. Negotiated Rate	$4,966.61
Rate for Payer: AHCCCS Medicaid	$4,966.61
Rate for Payer: Allwell Medicaid	$4,966.61
Rate for Payer: AZCH Complete Medicaid	$4,966.61
Rate for Payer: Banner UC Health Medicaid	$4,966.61
Rate for Payer: Mercy Care Medicaid	$4,966.61

Septicemia And Disseminated Infections

Facility

IP

$7,570.91

Service Code	APR-DRG 7203
Hospital Charge Code	APRDRG7203
Min. Negotiated Rate	$7,570.91
Max. Negotiated Rate	$7,570.91
Rate for Payer: AHCCCS Medicaid	$7,570.91
Rate for Payer: Allwell Medicaid	$7,570.91
Rate for Payer: AZCH Complete Medicaid	$7,570.91
Rate for Payer: Banner UC Health Medicaid	$7,570.91
Rate for Payer: Mercy Care Medicaid	$7,570.91

Septicemia And Disseminated Infections

Facility

IP

$4,966.61

Service Code	APR-DRG 7202
Hospital Charge Code	APRDRG7203
Min. Negotiated Rate	$4,966.61
Max. Negotiated Rate	$4,966.61
Rate for Payer: AHCCCS Medicaid	$4,966.61
Rate for Payer: Allwell Medicaid	$4,966.61
Rate for Payer: AZCH Complete Medicaid	$4,966.61
Rate for Payer: Banner UC Health Medicaid	$4,966.61
Rate for Payer: Mercy Care Medicaid	$4,966.61

Septicemia And Disseminated Infections

Facility

IP

$3,873.13

Service Code	APR-DRG 7201
Hospital Charge Code	APRDRG7204
Min. Negotiated Rate	$3,873.13
Max. Negotiated Rate	$3,873.13
Rate for Payer: AHCCCS Medicaid	$3,873.13
Rate for Payer: Allwell Medicaid	$3,873.13
Rate for Payer: AZCH Complete Medicaid	$3,873.13
Rate for Payer: Banner UC Health Medicaid	$3,873.13
Rate for Payer: Mercy Care Medicaid	$3,873.13

SEROTONIN

Facility

OP

$124.00

Service Code	CPT 84260
Hospital Charge Code	28010054
Hospital Revenue Code	302
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Aetna of AZ Medicare	$34.72
Rate for Payer: Allwell Medicare	$19.84
Rate for Payer: Amerigroup Medicare	$19.84
Rate for Payer: APIPA Medicare/Medicaid	$46.31
Rate for Payer: AZCH Complete Medicare	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$84.32
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$80.60
Rate for Payer: Copperpoint Commercial	$30.69
Rate for Payer: Health Net of AZ Commercial	$74.40
Rate for Payer: Health Net of AZ Medicare	$34.72
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Self Pay Self Pay	$99.20
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.32

SEROTONIN

Facility

IP

$124.00

Service Code	CPT 84260
Hospital Charge Code	28010054
Hospital Revenue Code	302
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Bisbee Police All Plans	$32.24
Rate for Payer: Cash Price	$99.20
Rate for Payer: Self Pay Self Pay	$99.20

sertraline 50 mg Tab [CQCH]

Facility

OP

$0.21

Service Code	NDC 60687024201
Hospital Charge Code	105940109
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.08
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	$0.14
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.13
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.17
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

sertraline 50 mg Tab [CQCH]

Facility

IP

$0.21

Service Code	NDC 60687024201
Hospital Charge Code	105940109
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.19
Rate for Payer: Aetna of AZ Commercial	$0.19
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.17
Rate for Payer: Self Pay Self Pay	$0.17

Services performed by qualified Physical Therapist in the ho

Facility

OP

$215.00

Service Code	CPT G0151
Hospital Charge Code	27342346
Hospital Revenue Code	420
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Aetna of AZ Medicare	$60.20
Rate for Payer: Allwell Medicare	$34.40
Rate for Payer: Amerigroup Medicare	$34.40
Rate for Payer: APIPA Medicare/Medicaid	$80.30
Rate for Payer: AZCH Complete Medicare	$34.40
Rate for Payer: Banner UC Health Medicare	$34.40
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.20
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cigna of AZ Commercial	$150.50
Rate for Payer: Copperpoint Commercial	$53.21
Rate for Payer: Health Net of AZ Commercial	$129.00
Rate for Payer: Health Net of AZ Medicare	$60.20
Rate for Payer: Humana of AZ Medicare	$34.40
Rate for Payer: Self Pay Self Pay	$172.00
Rate for Payer: TriWest Medicare	$34.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.70

Services performed by qualified Physical Therapist in the ho

Facility

IP

$215.00

Service Code	CPT G0151
Hospital Charge Code	27342346
Hospital Revenue Code	420
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Cash Price	$172.00
Rate for Payer: Self Pay Self Pay	$172.00

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