Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$27,684.26

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG0081
Min. Negotiated Rate	$27,684.26
Max. Negotiated Rate	$27,684.26
Rate for Payer: AHCCCS Medicaid	$27,684.26
Rate for Payer: Allwell Medicaid	$27,684.26
Rate for Payer: AZCH Complete Medicaid	$27,684.26
Rate for Payer: Banner UC Health Medicaid	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$62,166.48

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG0081
Min. Negotiated Rate	$62,166.48
Max. Negotiated Rate	$62,166.48
Rate for Payer: AHCCCS Medicaid	$62,166.48
Rate for Payer: Allwell Medicaid	$62,166.48
Rate for Payer: AZCH Complete Medicaid	$62,166.48
Rate for Payer: Banner UC Health Medicaid	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$33,226.72

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG0084
Min. Negotiated Rate	$33,226.72
Max. Negotiated Rate	$33,226.72
Rate for Payer: AHCCCS Medicaid	$33,226.72
Rate for Payer: Allwell Medicaid	$33,226.72
Rate for Payer: AZCH Complete Medicaid	$33,226.72
Rate for Payer: Banner UC Health Medicaid	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$33,226.72

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG0083
Min. Negotiated Rate	$33,226.72
Max. Negotiated Rate	$33,226.72
Rate for Payer: AHCCCS Medicaid	$33,226.72
Rate for Payer: Allwell Medicaid	$33,226.72
Rate for Payer: AZCH Complete Medicaid	$33,226.72
Rate for Payer: Banner UC Health Medicaid	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$27,684.26

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG0084
Min. Negotiated Rate	$27,684.26
Max. Negotiated Rate	$27,684.26
Rate for Payer: AHCCCS Medicaid	$27,684.26
Rate for Payer: Allwell Medicaid	$27,684.26
Rate for Payer: AZCH Complete Medicaid	$27,684.26
Rate for Payer: Banner UC Health Medicaid	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$38,943.83

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG0081
Min. Negotiated Rate	$38,943.83
Max. Negotiated Rate	$38,943.83
Rate for Payer: AHCCCS Medicaid	$38,943.83
Rate for Payer: Allwell Medicaid	$38,943.83
Rate for Payer: AZCH Complete Medicaid	$38,943.83
Rate for Payer: Banner UC Health Medicaid	$38,943.83
Rate for Payer: Mercy Care Medicaid	$38,943.83

AVITENE 1.0 GM MICROFIBRILLAR COLLAGEN HEMOSTAT

Facility

OP

$1,200.00

Hospital Charge Code	23223473
Hospital Revenue Code	272
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna of AZ Commercial	$1,080.00
Rate for Payer: Aetna of AZ Medicare	$336.00
Rate for Payer: Allwell Medicare	$180.00
Rate for Payer: Amerigroup Medicare	$180.00
Rate for Payer: APIPA Medicare/Medicaid	$448.20
Rate for Payer: AZCH Complete Medicare	$180.00
Rate for Payer: Banner UC Health Medicare	$180.00
Rate for Payer: Bisbee Police All Plans	$312.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$816.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Cigna of AZ Commercial	$840.00
Rate for Payer: Copperpoint Commercial	$297.00
Rate for Payer: Health Net of AZ Commercial	$720.00
Rate for Payer: Health Net of AZ Medicare	$336.00
Rate for Payer: Humana of AZ Medicare	$180.00
Rate for Payer: Self Pay Self Pay	$960.00
Rate for Payer: TriWest Medicare	$180.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$699.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$216.00

AVITENE 1.0 GM MICROFIBRILLAR COLLAGEN HEMOSTAT

Facility

IP

$1,200.00

Hospital Charge Code	23223473
Hospital Revenue Code	272
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna of AZ Commercial	$1,080.00
Rate for Payer: Bisbee Police All Plans	$312.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Self Pay Self Pay	$960.00

AXIOFILL 500MG

Facility

IP

$9,288.00

Hospital Charge Code	27469180
Hospital Revenue Code	270
Min. Negotiated Rate	$2,414.88
Max. Negotiated Rate	$8,359.20
Rate for Payer: Aetna of AZ Commercial	$8,359.20
Rate for Payer: Bisbee Police All Plans	$2,414.88
Rate for Payer: Cash Price	$7,430.40
Rate for Payer: Self Pay Self Pay	$7,430.40

AXIOFILL 500MG

Facility

OP

$9,288.00

Hospital Charge Code	27469180
Hospital Revenue Code	270
Min. Negotiated Rate	$1,393.20
Max. Negotiated Rate	$8,359.20
Rate for Payer: Aetna of AZ Commercial	$8,359.20
Rate for Payer: Aetna of AZ Medicare	$2,600.64
Rate for Payer: Allwell Medicare	$1,393.20
Rate for Payer: Amerigroup Medicare	$1,393.20
Rate for Payer: APIPA Medicare/Medicaid	$3,469.07
Rate for Payer: AZCH Complete Medicare	$1,393.20
Rate for Payer: Banner UC Health Medicare	$1,393.20
Rate for Payer: Bisbee Police All Plans	$2,414.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6,315.84
Rate for Payer: Cash Price	$7,430.40
Rate for Payer: Cigna of AZ Commercial	$6,501.60
Rate for Payer: Copperpoint Commercial	$2,298.78
Rate for Payer: Health Net of AZ Commercial	$5,572.80
Rate for Payer: Health Net of AZ Medicare	$2,600.64
Rate for Payer: Humana of AZ Medicare	$1,393.20
Rate for Payer: Self Pay Self Pay	$7,430.40
Rate for Payer: TriWest Medicare	$1,393.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,414.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,671.84

AXIS DERMIS 6CM X 12CM

Facility

IP

$13,145.00

Hospital Charge Code	27540060
Hospital Revenue Code	270
Min. Negotiated Rate	$3,417.70
Max. Negotiated Rate	$11,830.50
Rate for Payer: Aetna of AZ Commercial	$11,830.50
Rate for Payer: Bisbee Police All Plans	$3,417.70
Rate for Payer: Cash Price	$10,516.00
Rate for Payer: Self Pay Self Pay	$10,516.00

AXIS DERMIS 6CM X 12CM

Facility

OP

$13,145.00

Hospital Charge Code	27540060
Hospital Revenue Code	270
Min. Negotiated Rate	$1,971.75
Max. Negotiated Rate	$11,830.50
Rate for Payer: Aetna of AZ Commercial	$11,830.50
Rate for Payer: Aetna of AZ Medicare	$3,680.60
Rate for Payer: Allwell Medicare	$1,971.75
Rate for Payer: Amerigroup Medicare	$1,971.75
Rate for Payer: APIPA Medicare/Medicaid	$4,909.66
Rate for Payer: AZCH Complete Medicare	$1,971.75
Rate for Payer: Banner UC Health Medicare	$1,971.75
Rate for Payer: Bisbee Police All Plans	$3,417.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8,938.60
Rate for Payer: Cash Price	$10,516.00
Rate for Payer: Cigna of AZ Commercial	$9,201.50
Rate for Payer: Copperpoint Commercial	$3,253.39
Rate for Payer: Health Net of AZ Commercial	$7,887.00
Rate for Payer: Health Net of AZ Medicare	$3,680.60
Rate for Payer: Humana of AZ Medicare	$1,971.75
Rate for Payer: Self Pay Self Pay	$10,516.00
Rate for Payer: TriWest Medicare	$1,971.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$7,663.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,366.10

azithromycin 200 mg/5 mL Oral Susp (22.5mL after reconst) [CQCH]

Facility

IP

$1.15

Service Code	HCPCS Q0144
Hospital Charge Code	105947029
Hospital Revenue Code	251
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.04
Rate for Payer: Aetna of AZ Commercial	$1.04
Rate for Payer: Bisbee Police All Plans	$0.30
Rate for Payer: Cash Price	$0.92
Rate for Payer: Self Pay Self Pay	$0.92

azithromycin 200 mg/5 mL Oral Susp (22.5mL after reconst) [CQCH]

Facility

OP

$1.15

Service Code	HCPCS Q0144
Hospital Charge Code	105947029
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna of AZ Commercial	$1.04
Rate for Payer: Aetna of AZ Medicare	$0.32
Rate for Payer: AHCCCS Medicaid	$2.12
Rate for Payer: Allwell Medicaid	$2.12
Rate for Payer: Allwell Medicare	$0.17
Rate for Payer: Amerigroup Medicare	$0.17
Rate for Payer: APIPA Medicare/Medicaid	$0.43
Rate for Payer: AZCH Complete Medicaid	$2.12
Rate for Payer: AZCH Complete Medicare	$0.17
Rate for Payer: Banner UC Health Medicaid	$2.12
Rate for Payer: Banner UC Health Medicare	$0.17
Rate for Payer: Bisbee Police All Plans	$0.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.78
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cigna of AZ Commercial	$0.75
Rate for Payer: Copperpoint Commercial	$0.28
Rate for Payer: Health Net of AZ Commercial	$0.69
Rate for Payer: Health Net of AZ Medicare	$0.32
Rate for Payer: Humana of AZ Medicare	$0.17
Rate for Payer: Mercy Care Medicaid	$2.12
Rate for Payer: Self Pay Self Pay	$0.92
Rate for Payer: TriWest Medicare	$0.17
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.21

azithromycin 250 mg Tab [CQCH]

Facility

IP

$0.63

Service Code	NDC 904670806
Hospital Charge Code	105912444
Hospital Revenue Code	251
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.51
Rate for Payer: Self Pay Self Pay	$0.50

azithromycin 250 mg Tab [CQCH]

Facility

OP

$0.63

Service Code	NDC 904670806
Hospital Charge Code	105912444
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.57
Rate for Payer: Aetna of AZ Commercial	$0.57
Rate for Payer: Aetna of AZ Medicare	$0.18
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.24
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.43
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of AZ Commercial	$0.41
Rate for Payer: Copperpoint Commercial	$0.16
Rate for Payer: Health Net of AZ Commercial	$0.38
Rate for Payer: Health Net of AZ Medicare	$0.18
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

azithromycin 500 mg IV Inj [CQCH]

Facility

IP

$2.26

Service Code	HCPCS J0456
Hospital Charge Code	105948837
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.03
Rate for Payer: Aetna of AZ Commercial	$2.03
Rate for Payer: Bisbee Police All Plans	$0.59
Rate for Payer: Cash Price	$1.81
Rate for Payer: Self Pay Self Pay	$1.81

azithromycin 500 mg IV Inj [CQCH]

Facility

OP

$2.26

Service Code	HCPCS J0456
Hospital Charge Code	105948837
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$4.88
Rate for Payer: Aetna of AZ Commercial	$2.03
Rate for Payer: Aetna of AZ Medicare	$0.63
Rate for Payer: AHCCCS Medicaid	$4.88
Rate for Payer: Allwell Medicaid	$4.88
Rate for Payer: Allwell Medicare	$0.34
Rate for Payer: Amerigroup Medicare	$0.34
Rate for Payer: APIPA Medicare/Medicaid	$0.84
Rate for Payer: AZCH Complete Medicaid	$4.88
Rate for Payer: AZCH Complete Medicare	$0.34
Rate for Payer: Banner UC Health Medicaid	$4.88
Rate for Payer: Banner UC Health Medicare	$0.34
Rate for Payer: Bisbee Police All Plans	$0.59
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.54
Rate for Payer: Cash Price	$1.81
Rate for Payer: Cash Price	$1.81
Rate for Payer: Cigna of AZ Commercial	$1.47
Rate for Payer: Copperpoint Commercial	$0.56
Rate for Payer: Health Net of AZ Commercial	$1.36
Rate for Payer: Health Net of AZ Medicare	$0.63
Rate for Payer: Humana of AZ Medicare	$0.34
Rate for Payer: Mercy Care Medicaid	$4.88
Rate for Payer: Self Pay Self Pay	$1.81
Rate for Payer: TriWest Medicare	$0.34
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.41

bacitracin/neomycin/polymyxin B Top Oint [CQCH]

Facility

OP

$0.14

Service Code	NDC 45802014370
Hospital Charge Code	105912512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.09
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.11
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

bacitracin/neomycin/polymyxin B Top Oint [CQCH]

Facility

IP

$0.14

Service Code	NDC 45802014370
Hospital Charge Code	105912512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.11
Rate for Payer: Self Pay Self Pay	$0.11

bacitracin topical 500 units/g Oin[CQCH]

Facility

OP

$0.20

Service Code	NDC 713028031
Hospital Charge Code	168975217
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
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	$0.07
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	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
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	$0.16
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

bacitracin topical 500 units/g Oin[CQCH]

Facility

IP

$0.20

Service Code	NDC 713028031
Hospital Charge Code	168975217
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

baclofen 10 mg Tab [CQCH]

Facility

OP

$0.33

Service Code	NDC 63739047910
Hospital Charge Code	105965598
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.22
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.20
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.26
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

baclofen 10 mg Tab [CQCH]

Facility

IP

$0.33

Service Code	NDC 63739047910
Hospital Charge Code	105965598
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.26
Rate for Payer: Self Pay Self Pay	$0.26

Bacterial And Tuberculous Infections Of Nervous System

Facility

IP

$27,128.05

Service Code	APR-DRG 0494
Hospital Charge Code	APRDRG0491
Min. Negotiated Rate	$27,128.05
Max. Negotiated Rate	$27,128.05
Rate for Payer: AHCCCS Medicaid	$27,128.05
Rate for Payer: Allwell Medicaid	$27,128.05
Rate for Payer: AZCH Complete Medicaid	$27,128.05
Rate for Payer: Banner UC Health Medicaid	$27,128.05
Rate for Payer: Mercy Care Medicaid	$27,128.05

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