Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Breast Procedures Except Mastectomy

Facility

IP

$8,104.68

Service Code	APR-DRG 3631
Hospital Charge Code	APRDRG3632
Min. Negotiated Rate	$8,104.68
Max. Negotiated Rate	$8,104.68
Rate for Payer: AHCCCS Medicaid	$8,104.68
Rate for Payer: Allwell Medicaid	$8,104.68
Rate for Payer: AZCH Complete Medicaid	$8,104.68
Rate for Payer: Banner UC Health Medicaid	$8,104.68
Rate for Payer: Mercy Care Medicaid	$8,104.68

Breast Procedures Except Mastectomy

Facility

IP

$13,972.59

Service Code	APR-DRG 3632
Hospital Charge Code	APRDRG3631
Min. Negotiated Rate	$13,972.59
Max. Negotiated Rate	$13,972.59
Rate for Payer: AHCCCS Medicaid	$13,972.59
Rate for Payer: Allwell Medicaid	$13,972.59
Rate for Payer: AZCH Complete Medicaid	$13,972.59
Rate for Payer: Banner UC Health Medicaid	$13,972.59
Rate for Payer: Mercy Care Medicaid	$13,972.59

Breast Procedures Except Mastectomy

Facility

IP

$13,972.59

Service Code	APR-DRG 3632
Hospital Charge Code	APRDRG3632
Min. Negotiated Rate	$13,972.59
Max. Negotiated Rate	$13,972.59
Rate for Payer: AHCCCS Medicaid	$13,972.59
Rate for Payer: Allwell Medicaid	$13,972.59
Rate for Payer: AZCH Complete Medicaid	$13,972.59
Rate for Payer: Banner UC Health Medicaid	$13,972.59
Rate for Payer: Mercy Care Medicaid	$13,972.59

Breast Procedures Except Mastectomy

Facility

IP

$17,151.33

Service Code	APR-DRG 3633
Hospital Charge Code	APRDRG3632
Min. Negotiated Rate	$17,151.33
Max. Negotiated Rate	$17,151.33
Rate for Payer: AHCCCS Medicaid	$17,151.33
Rate for Payer: Allwell Medicaid	$17,151.33
Rate for Payer: AZCH Complete Medicaid	$17,151.33
Rate for Payer: Banner UC Health Medicaid	$17,151.33
Rate for Payer: Mercy Care Medicaid	$17,151.33

Breast Procedures Except Mastectomy

Facility

IP

$13,972.59

Service Code	APR-DRG 3632
Hospital Charge Code	APRDRG3634
Min. Negotiated Rate	$13,972.59
Max. Negotiated Rate	$13,972.59
Rate for Payer: AHCCCS Medicaid	$13,972.59
Rate for Payer: Allwell Medicaid	$13,972.59
Rate for Payer: AZCH Complete Medicaid	$13,972.59
Rate for Payer: Banner UC Health Medicaid	$13,972.59
Rate for Payer: Mercy Care Medicaid	$13,972.59

Breast Procedures Except Mastectomy

Facility

IP

$8,104.68

Service Code	APR-DRG 3631
Hospital Charge Code	APRDRG3631
Min. Negotiated Rate	$8,104.68
Max. Negotiated Rate	$8,104.68
Rate for Payer: AHCCCS Medicaid	$8,104.68
Rate for Payer: Allwell Medicaid	$8,104.68
Rate for Payer: AZCH Complete Medicaid	$8,104.68
Rate for Payer: Banner UC Health Medicaid	$8,104.68
Rate for Payer: Mercy Care Medicaid	$8,104.68

Breast Procedures Except Mastectomy

Facility

IP

$8,104.68

Service Code	APR-DRG 3631
Hospital Charge Code	APRDRG3634
Min. Negotiated Rate	$8,104.68
Max. Negotiated Rate	$8,104.68
Rate for Payer: AHCCCS Medicaid	$8,104.68
Rate for Payer: Allwell Medicaid	$8,104.68
Rate for Payer: AZCH Complete Medicaid	$8,104.68
Rate for Payer: Banner UC Health Medicaid	$8,104.68
Rate for Payer: Mercy Care Medicaid	$8,104.68

Breast Procedures Except Mastectomy

Facility

IP

$8,104.68

Service Code	APR-DRG 3631
Hospital Charge Code	APRDRG3633
Min. Negotiated Rate	$8,104.68
Max. Negotiated Rate	$8,104.68
Rate for Payer: AHCCCS Medicaid	$8,104.68
Rate for Payer: Allwell Medicaid	$8,104.68
Rate for Payer: AZCH Complete Medicaid	$8,104.68
Rate for Payer: Banner UC Health Medicaid	$8,104.68
Rate for Payer: Mercy Care Medicaid	$8,104.68

Breast Procedures Except Mastectomy

Facility

IP

$24,191.29

Service Code	APR-DRG 3634
Hospital Charge Code	APRDRG3634
Min. Negotiated Rate	$24,191.29
Max. Negotiated Rate	$24,191.29
Rate for Payer: AHCCCS Medicaid	$24,191.29
Rate for Payer: Allwell Medicaid	$24,191.29
Rate for Payer: AZCH Complete Medicaid	$24,191.29
Rate for Payer: Banner UC Health Medicaid	$24,191.29
Rate for Payer: Mercy Care Medicaid	$24,191.29

Breast Procedures Except Mastectomy

Facility

IP

$17,151.33

Service Code	APR-DRG 3633
Hospital Charge Code	APRDRG3631
Min. Negotiated Rate	$17,151.33
Max. Negotiated Rate	$17,151.33
Rate for Payer: AHCCCS Medicaid	$17,151.33
Rate for Payer: Allwell Medicaid	$17,151.33
Rate for Payer: AZCH Complete Medicaid	$17,151.33
Rate for Payer: Banner UC Health Medicaid	$17,151.33
Rate for Payer: Mercy Care Medicaid	$17,151.33

Breast Procedures Except Mastectomy

Facility

IP

$24,191.29

Service Code	APR-DRG 3634
Hospital Charge Code	APRDRG3631
Min. Negotiated Rate	$24,191.29
Max. Negotiated Rate	$24,191.29
Rate for Payer: AHCCCS Medicaid	$24,191.29
Rate for Payer: Allwell Medicaid	$24,191.29
Rate for Payer: AZCH Complete Medicaid	$24,191.29
Rate for Payer: Banner UC Health Medicaid	$24,191.29
Rate for Payer: Mercy Care Medicaid	$24,191.29

Breast Procedures Except Mastectomy

Facility

IP

$17,151.33

Service Code	APR-DRG 3633
Hospital Charge Code	APRDRG3634
Min. Negotiated Rate	$17,151.33
Max. Negotiated Rate	$17,151.33
Rate for Payer: AHCCCS Medicaid	$17,151.33
Rate for Payer: Allwell Medicaid	$17,151.33
Rate for Payer: AZCH Complete Medicaid	$17,151.33
Rate for Payer: Banner UC Health Medicaid	$17,151.33
Rate for Payer: Mercy Care Medicaid	$17,151.33

BREATHING CIRCUIT

Facility

OP

$27.00

Hospital Charge Code	22355324
Hospital Revenue Code	270
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Aetna of AZ Medicare	$7.56
Rate for Payer: Allwell Medicare	$4.32
Rate for Payer: Amerigroup Medicare	$4.32
Rate for Payer: APIPA Medicare/Medicaid	$10.08
Rate for Payer: AZCH Complete Medicare	$4.32
Rate for Payer: Banner UC Health Medicare	$4.32
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$18.36
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna of AZ Commercial	$18.90
Rate for Payer: Copperpoint Commercial	$6.68
Rate for Payer: Health Net of AZ Commercial	$16.20
Rate for Payer: Health Net of AZ Medicare	$7.56
Rate for Payer: Humana of AZ Medicare	$4.32
Rate for Payer: Self Pay Self Pay	$21.60
Rate for Payer: TriWest Medicare	$4.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$15.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.86

BREATHING CIRCUIT

Facility

IP

$27.00

Hospital Charge Code	22355324
Hospital Revenue Code	270
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$24.30
Rate for Payer: Aetna of AZ Commercial	$24.30
Rate for Payer: Bisbee Police All Plans	$7.02
Rate for Payer: Cash Price	$21.60
Rate for Payer: Self Pay Self Pay	$21.60

BREATHING CIRCUIT PED

Facility

OP

$96.00

Hospital Charge Code	22355318
Hospital Revenue Code	270
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna of AZ Commercial	$86.40
Rate for Payer: Aetna of AZ Medicare	$26.88
Rate for Payer: Allwell Medicare	$15.36
Rate for Payer: Amerigroup Medicare	$15.36
Rate for Payer: APIPA Medicare/Medicaid	$35.86
Rate for Payer: AZCH Complete Medicare	$15.36
Rate for Payer: Banner UC Health Medicare	$15.36
Rate for Payer: Bisbee Police All Plans	$24.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.28
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cigna of AZ Commercial	$67.20
Rate for Payer: Copperpoint Commercial	$23.76
Rate for Payer: Health Net of AZ Commercial	$57.60
Rate for Payer: Health Net of AZ Medicare	$26.88
Rate for Payer: Humana of AZ Medicare	$15.36
Rate for Payer: Self Pay Self Pay	$76.80
Rate for Payer: TriWest Medicare	$15.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.28

BREATHING CIRCUIT PED

Facility

IP

$96.00

Hospital Charge Code	22355318
Hospital Revenue Code	270
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna of AZ Commercial	$86.40
Rate for Payer: Bisbee Police All Plans	$24.96
Rate for Payer: Cash Price	$76.80
Rate for Payer: Self Pay Self Pay	$76.80

brompheniramine-pseudoephedrine 118 mL Bulk Liq [CQCH]

Facility

OP

$0.07

Service Code	NDC 603085194
Hospital Charge Code	107994381
Hospital Revenue Code	250
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

brompheniramine-pseudoephedrine 118 mL Bulk Liq [CQCH]

Facility

IP

$0.07

Service Code	NDC 603085194
Hospital Charge Code	107994381
Hospital Revenue Code	250
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

Bronchiolitis And Rsv Pneumonia

Facility

IP

$5,424.63

Service Code	APR-DRG 1383
Hospital Charge Code	APRDRG1383
Min. Negotiated Rate	$5,424.63
Max. Negotiated Rate	$5,424.63
Rate for Payer: AHCCCS Medicaid	$5,424.63
Rate for Payer: Allwell Medicaid	$5,424.63
Rate for Payer: AZCH Complete Medicaid	$5,424.63
Rate for Payer: Banner UC Health Medicaid	$5,424.63
Rate for Payer: Mercy Care Medicaid	$5,424.63

Bronchiolitis And Rsv Pneumonia

Facility

IP

$2,151.19

Service Code	APR-DRG 1381
Hospital Charge Code	APRDRG1382
Min. Negotiated Rate	$2,151.19
Max. Negotiated Rate	$2,151.19
Rate for Payer: AHCCCS Medicaid	$2,151.19
Rate for Payer: Allwell Medicaid	$2,151.19
Rate for Payer: AZCH Complete Medicaid	$2,151.19
Rate for Payer: Banner UC Health Medicaid	$2,151.19
Rate for Payer: Mercy Care Medicaid	$2,151.19

Bronchiolitis And Rsv Pneumonia

Facility

IP

$5,424.63

Service Code	APR-DRG 1383
Hospital Charge Code	APRDRG1382
Min. Negotiated Rate	$5,424.63
Max. Negotiated Rate	$5,424.63
Rate for Payer: AHCCCS Medicaid	$5,424.63
Rate for Payer: Allwell Medicaid	$5,424.63
Rate for Payer: AZCH Complete Medicaid	$5,424.63
Rate for Payer: Banner UC Health Medicaid	$5,424.63
Rate for Payer: Mercy Care Medicaid	$5,424.63

Bronchiolitis And Rsv Pneumonia

Facility

IP

$2,151.19

Service Code	APR-DRG 1381
Hospital Charge Code	APRDRG1384
Min. Negotiated Rate	$2,151.19
Max. Negotiated Rate	$2,151.19
Rate for Payer: AHCCCS Medicaid	$2,151.19
Rate for Payer: Allwell Medicaid	$2,151.19
Rate for Payer: AZCH Complete Medicaid	$2,151.19
Rate for Payer: Banner UC Health Medicaid	$2,151.19
Rate for Payer: Mercy Care Medicaid	$2,151.19

Bronchiolitis And Rsv Pneumonia

Facility

IP

$12,683.42

Service Code	APR-DRG 1384
Hospital Charge Code	APRDRG1383
Min. Negotiated Rate	$12,683.42
Max. Negotiated Rate	$12,683.42
Rate for Payer: AHCCCS Medicaid	$12,683.42
Rate for Payer: Allwell Medicaid	$12,683.42
Rate for Payer: AZCH Complete Medicaid	$12,683.42
Rate for Payer: Banner UC Health Medicaid	$12,683.42
Rate for Payer: Mercy Care Medicaid	$12,683.42

Bronchiolitis And Rsv Pneumonia

Facility

IP

$12,683.42

Service Code	APR-DRG 1384
Hospital Charge Code	APRDRG1382
Min. Negotiated Rate	$12,683.42
Max. Negotiated Rate	$12,683.42
Rate for Payer: AHCCCS Medicaid	$12,683.42
Rate for Payer: Allwell Medicaid	$12,683.42
Rate for Payer: AZCH Complete Medicaid	$12,683.42
Rate for Payer: Banner UC Health Medicaid	$12,683.42
Rate for Payer: Mercy Care Medicaid	$12,683.42

Bronchiolitis And Rsv Pneumonia

Facility

IP

$3,197.68

Service Code	APR-DRG 1382
Hospital Charge Code	APRDRG1382
Min. Negotiated Rate	$3,197.68
Max. Negotiated Rate	$3,197.68
Rate for Payer: AHCCCS Medicaid	$3,197.68
Rate for Payer: Allwell Medicaid	$3,197.68
Rate for Payer: AZCH Complete Medicaid	$3,197.68
Rate for Payer: Banner UC Health Medicaid	$3,197.68
Rate for Payer: Mercy Care Medicaid	$3,197.68

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