Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$4,167.02

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: AHCCCS Medicaid	$4,167.02
Rate for Payer: Allwell Medicaid	$4,167.02
Rate for Payer: AZCH Complete Medicaid	$4,167.02
Rate for Payer: Banner UC Health Medicaid	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$9,865.19

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: AHCCCS Medicaid	$9,865.19
Rate for Payer: Allwell Medicaid	$9,865.19
Rate for Payer: AZCH Complete Medicaid	$9,865.19
Rate for Payer: Banner UC Health Medicaid	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$3,340.07

Service Code	APR-DRG 8611
Hospital Charge Code	APRDRG8614
Min. Negotiated Rate	$3,340.07
Max. Negotiated Rate	$3,340.07
Rate for Payer: AHCCCS Medicaid	$3,340.07
Rate for Payer: Allwell Medicaid	$3,340.07
Rate for Payer: AZCH Complete Medicaid	$3,340.07
Rate for Payer: Banner UC Health Medicaid	$3,340.07
Rate for Payer: Mercy Care Medicaid	$3,340.07

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$5,985.05

Service Code	APR-DRG 8613
Hospital Charge Code	APRDRG8614
Min. Negotiated Rate	$5,985.05
Max. Negotiated Rate	$5,985.05
Rate for Payer: AHCCCS Medicaid	$5,985.05
Rate for Payer: Allwell Medicaid	$5,985.05
Rate for Payer: AZCH Complete Medicaid	$5,985.05
Rate for Payer: Banner UC Health Medicaid	$5,985.05
Rate for Payer: Mercy Care Medicaid	$5,985.05

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$9,865.19

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG8614
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: AHCCCS Medicaid	$9,865.19
Rate for Payer: Allwell Medicaid	$9,865.19
Rate for Payer: AZCH Complete Medicaid	$9,865.19
Rate for Payer: Banner UC Health Medicaid	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$5,985.05

Service Code	APR-DRG 8613
Hospital Charge Code	APRDRG8613
Min. Negotiated Rate	$5,985.05
Max. Negotiated Rate	$5,985.05
Rate for Payer: AHCCCS Medicaid	$5,985.05
Rate for Payer: Allwell Medicaid	$5,985.05
Rate for Payer: AZCH Complete Medicaid	$5,985.05
Rate for Payer: Banner UC Health Medicaid	$5,985.05
Rate for Payer: Mercy Care Medicaid	$5,985.05

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$4,167.02

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG8614
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: AHCCCS Medicaid	$4,167.02
Rate for Payer: Allwell Medicaid	$4,167.02
Rate for Payer: AZCH Complete Medicaid	$4,167.02
Rate for Payer: Banner UC Health Medicaid	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$3,340.07

Service Code	APR-DRG 8611
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$3,340.07
Max. Negotiated Rate	$3,340.07
Rate for Payer: AHCCCS Medicaid	$3,340.07
Rate for Payer: Allwell Medicaid	$3,340.07
Rate for Payer: AZCH Complete Medicaid	$3,340.07
Rate for Payer: Banner UC Health Medicaid	$3,340.07
Rate for Payer: Mercy Care Medicaid	$3,340.07

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$4,167.02

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG8613
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: AHCCCS Medicaid	$4,167.02
Rate for Payer: Allwell Medicaid	$4,167.02
Rate for Payer: AZCH Complete Medicaid	$4,167.02
Rate for Payer: Banner UC Health Medicaid	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$9,865.19

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG8611
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: AHCCCS Medicaid	$9,865.19
Rate for Payer: Allwell Medicaid	$9,865.19
Rate for Payer: AZCH Complete Medicaid	$9,865.19
Rate for Payer: Banner UC Health Medicaid	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$4,167.02

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG8612
Min. Negotiated Rate	$4,167.02
Max. Negotiated Rate	$4,167.02
Rate for Payer: AHCCCS Medicaid	$4,167.02
Rate for Payer: Allwell Medicaid	$4,167.02
Rate for Payer: AZCH Complete Medicaid	$4,167.02
Rate for Payer: Banner UC Health Medicaid	$4,167.02
Rate for Payer: Mercy Care Medicaid	$4,167.02

Signs, Symptoms And Other Factors Influencing Health Status

Facility

IP

$9,865.19

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG8613
Min. Negotiated Rate	$9,865.19
Max. Negotiated Rate	$9,865.19
Rate for Payer: AHCCCS Medicaid	$9,865.19
Rate for Payer: Allwell Medicaid	$9,865.19
Rate for Payer: AZCH Complete Medicaid	$9,865.19
Rate for Payer: Banner UC Health Medicaid	$9,865.19
Rate for Payer: Mercy Care Medicaid	$9,865.19

SILICONE EPISTAXIS BALLOON

Facility

IP

$290.00

Hospital Charge Code	27526363
Hospital Revenue Code	270
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

SILICONE EPISTAXIS BALLOON

Facility

OP

$290.00

Hospital Charge Code	27526363
Hospital Revenue Code	270
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$46.40
Rate for Payer: Amerigroup Medicare	$46.40
Rate for Payer: APIPA Medicare/Medicaid	$108.31
Rate for Payer: AZCH Complete Medicare	$46.40
Rate for Payer: Banner UC Health Medicare	$46.40
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$203.00
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$46.40
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$46.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

silver nitrate Top Stick [CQCH]

Facility

IP

$0.36

Service Code	NDC 12870000102
Hospital Charge Code	105940241
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.29
Rate for Payer: Self Pay Self Pay	$0.29

silver nitrate Top Stick [CQCH]

Facility

OP

$0.36

Service Code	NDC 12870000102
Hospital Charge Code	105940241
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.24
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.22
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.29
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

silver sulfADIAZINE Top 1% Crm 25 Gm [CQCH]

Facility

OP

$0.26

Service Code	NDC 43598021025
Hospital Charge Code	105940345
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Aetna of AZ Medicare	$0.07
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.10
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.18
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.17
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.16
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.21
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

silver sulfADIAZINE Top 1% Crm 25 Gm [CQCH]

Facility

IP

$0.26

Service Code	NDC 43598021025
Hospital Charge Code	105940345
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.21
Rate for Payer: Self Pay Self Pay	$0.21

silver sulfADIAZINE Top 1% Crm 400Gm [CQCH]

Facility

IP

$0.09

Service Code	NDC 61570013140
Hospital Charge Code	105940410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

silver sulfADIAZINE Top 1% Crm 400Gm [CQCH]

Facility

OP

$0.09

Service Code	NDC 61570013140
Hospital Charge Code	105940410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
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	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

simethicone 20 mg/0.3 mL Oral Liq [CQCH]

Facility

IP

$0.05

Service Code	NDC 603089450
Hospital Charge Code	105940540
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

simethicone 20 mg/0.3 mL Oral Liq [CQCH]

Facility

OP

$0.05

Service Code	NDC 603089450
Hospital Charge Code	105940540
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

simethicone 80 mg Chew Tab [CQCH]

Facility

IP

$0.02

Service Code	NDC 904506860
Hospital Charge Code	105940475
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.02

simethicone 80 mg Chew Tab [CQCH]

Facility

OP

$0.02

Service Code	NDC 904506860
Hospital Charge Code	105940475
Hospital Revenue Code	251
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
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	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
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

SIMPLE CHANGE OF BLADDER TUBE

Facility

OP

$270.00

Service Code	CPT 51705
Hospital Charge Code	28070629
Hospital Revenue Code	360
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$243.00
Rate for Payer: Aetna of AZ Medicare	$75.60
Rate for Payer: AHCCCS Medicaid	$192.95
Rate for Payer: Allwell Medicaid	$192.95
Rate for Payer: Allwell Medicare	$43.20
Rate for Payer: Amerigroup Medicare	$43.20
Rate for Payer: APIPA Medicare/Medicaid	$100.84
Rate for Payer: AZCH Complete Medicaid	$192.95
Rate for Payer: AZCH Complete Medicare	$43.20
Rate for Payer: Banner UC Health Medicaid	$192.95
Rate for Payer: Banner UC Health Medicare	$43.20
Rate for Payer: Bisbee Police All Plans	$70.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$183.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of AZ Commercial	$135.00
Rate for Payer: Copperpoint Commercial	$66.83
Rate for Payer: Health Net of AZ Commercial	$162.00
Rate for Payer: Health Net of AZ Medicare	$75.60
Rate for Payer: Humana of AZ Medicare	$43.20
Rate for Payer: Mercy Care Medicaid	$192.95
Rate for Payer: Self Pay Self Pay	$216.00
Rate for Payer: TriWest Medicare	$43.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.60

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