Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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

$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

$5,424.63

Service Code	APR-DRG 1383
Hospital Charge Code	APRDRG1381
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

$5,424.63

Service Code	APR-DRG 1383
Hospital Charge Code	APRDRG1384
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

$12,683.42

Service Code	APR-DRG 1384
Hospital Charge Code	APRDRG1381
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

$2,151.19

Service Code	APR-DRG 1381
Hospital Charge Code	APRDRG1381
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

$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

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

$3,197.68

Service Code	APR-DRG 1382
Hospital Charge Code	APRDRG1383
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

budesonide 0.5 mg/2 mL Inh [CQCH]

Facility

IP

$6.16

Service Code	HCPCS J7626
Hospital Charge Code	105913304
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$5.54
Rate for Payer: Aetna of AZ Commercial	$5.54
Rate for Payer: Bisbee Police All Plans	$1.60
Rate for Payer: Cash Price	$4.93
Rate for Payer: Self Pay Self Pay	$4.93

budesonide 0.5 mg/2 mL Inh [CQCH]

Facility

OP

$6.16

Service Code	HCPCS J7626
Hospital Charge Code	105913304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$5.54
Rate for Payer: Aetna of AZ Commercial	$5.54
Rate for Payer: Aetna of AZ Medicare	$1.72
Rate for Payer: Allwell Medicare	$0.99
Rate for Payer: Amerigroup Medicare	$0.99
Rate for Payer: APIPA Medicare/Medicaid	$2.30
Rate for Payer: AZCH Complete Medicare	$0.99
Rate for Payer: Banner UC Health Medicare	$0.99
Rate for Payer: Bisbee Police All Plans	$1.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4.19
Rate for Payer: Cash Price	$4.93
Rate for Payer: Cigna of AZ Commercial	$4.00
Rate for Payer: Copperpoint Commercial	$1.52
Rate for Payer: Health Net of AZ Commercial	$3.70
Rate for Payer: Health Net of AZ Medicare	$1.72
Rate for Payer: Humana of AZ Medicare	$0.99
Rate for Payer: Self Pay Self Pay	$4.93
Rate for Payer: TriWest Medicare	$0.99
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.11

BULB IRRIG W/TUBING PATH FINDER

Facility

IP

$292.59

Hospital Charge Code	22354307
Hospital Revenue Code	270
Min. Negotiated Rate	$76.07
Max. Negotiated Rate	$263.33
Rate for Payer: Aetna of AZ Commercial	$263.33
Rate for Payer: Bisbee Police All Plans	$76.07
Rate for Payer: Cash Price	$234.07
Rate for Payer: Self Pay Self Pay	$234.07

BULB IRRIG W/TUBING PATH FINDER

Facility

OP

$292.59

Hospital Charge Code	22354307
Hospital Revenue Code	270
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$263.33
Rate for Payer: Aetna of AZ Commercial	$263.33
Rate for Payer: Aetna of AZ Medicare	$81.93
Rate for Payer: Allwell Medicare	$46.81
Rate for Payer: Amerigroup Medicare	$46.81
Rate for Payer: APIPA Medicare/Medicaid	$109.28
Rate for Payer: AZCH Complete Medicare	$46.81
Rate for Payer: Banner UC Health Medicare	$46.81
Rate for Payer: Bisbee Police All Plans	$76.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$198.96
Rate for Payer: Cash Price	$234.07
Rate for Payer: Cigna of AZ Commercial	$204.81
Rate for Payer: Copperpoint Commercial	$72.42
Rate for Payer: Health Net of AZ Commercial	$175.55
Rate for Payer: Health Net of AZ Medicare	$81.93
Rate for Payer: Humana of AZ Medicare	$46.81
Rate for Payer: Self Pay Self Pay	$234.07
Rate for Payer: TriWest Medicare	$46.81
Rate for Payer: UnitedHealth Group of AZ Commercial	$170.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.67

Bulkamid INJECTION OF IMPLANT MATERIAL BENEATH LINING OF BLA

Facility

OP

$1,082.00

Service Code	CPT 51715
Hospital Charge Code	26811662
Hospital Revenue Code	360
Min. Negotiated Rate	$173.12
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$973.80
Rate for Payer: Aetna of AZ Medicare	$302.96
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$173.12
Rate for Payer: Amerigroup Medicare	$173.12
Rate for Payer: APIPA Medicare/Medicaid	$404.13
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$173.12
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$173.12
Rate for Payer: Bisbee Police All Plans	$281.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$735.76
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cigna of AZ Commercial	$541.00
Rate for Payer: Copperpoint Commercial	$267.80
Rate for Payer: Health Net of AZ Commercial	$649.20
Rate for Payer: Health Net of AZ Medicare	$302.96
Rate for Payer: Humana of AZ Medicare	$173.12
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$865.60
Rate for Payer: TriWest Medicare	$173.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$194.76

Bulkamid INJECTION OF IMPLANT MATERIAL BENEATH LINING OF BLA

Facility

IP

$1,082.00

Service Code	CPT 51715
Hospital Charge Code	26811662
Hospital Revenue Code	360
Min. Negotiated Rate	$281.32
Max. Negotiated Rate	$973.80
Rate for Payer: Aetna of AZ Commercial	$973.80
Rate for Payer: Bisbee Police All Plans	$281.32
Rate for Payer: Cash Price	$865.60
Rate for Payer: Self Pay Self Pay	$865.60

bumetanide 1 mg/ 4 mL Inj Sol [CQCH]

Facility

OP

$0.68

Service Code	NDC 641600810
Hospital Charge Code	105913379
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Aetna of AZ Medicare	$0.19
Rate for Payer: Allwell Medicare	$0.11
Rate for Payer: Amerigroup Medicare	$0.11
Rate for Payer: APIPA Medicare/Medicaid	$0.25
Rate for Payer: AZCH Complete Medicare	$0.11
Rate for Payer: Banner UC Health Medicare	$0.11
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.46
Rate for Payer: Cash Price	$0.55
Rate for Payer: Cigna of AZ Commercial	$0.44
Rate for Payer: Copperpoint Commercial	$0.17
Rate for Payer: Health Net of AZ Commercial	$0.41
Rate for Payer: Health Net of AZ Medicare	$0.19
Rate for Payer: Humana of AZ Medicare	$0.11
Rate for Payer: Self Pay Self Pay	$0.54
Rate for Payer: TriWest Medicare	$0.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.12

bumetanide 1 mg/ 4 mL Inj Sol [CQCH]

Facility

IP

$0.68

Service Code	NDC 641600810
Hospital Charge Code	105913379
Hospital Revenue Code	251
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.61
Rate for Payer: Aetna of AZ Commercial	$0.61
Rate for Payer: Bisbee Police All Plans	$0.18
Rate for Payer: Cash Price	$0.55
Rate for Payer: Self Pay Self Pay	$0.54

bumetanide 2.5 mg/10 mL Sol [CQCH]

Facility

IP

$0.28

Service Code	NDC 641600710
Hospital Charge Code	154090077
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of AZ Commercial	$0.25
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.22
Rate for Payer: Self Pay Self Pay	$0.22

bumetanide 2.5 mg/10 mL Sol [CQCH]

Facility

OP

$0.28

Service Code	NDC 641600710
Hospital Charge Code	154090077
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of AZ Commercial	$0.25
Rate for Payer: Aetna of AZ Medicare	$0.08
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	$0.19
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of AZ Commercial	$0.18
Rate for Payer: Copperpoint Commercial	$0.07
Rate for Payer: Health Net of AZ Commercial	$0.17
Rate for Payer: Health Net of AZ Medicare	$0.08
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.22
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

BUN+Creat(Dialysate) LC

Facility

IP

$91.00

Hospital Charge Code	22311179
Hospital Revenue Code	301
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Cash Price	$72.80
Rate for Payer: Self Pay Self Pay	$72.80

BUN+Creat(Dialysate) LC

Facility

OP

$91.00

Hospital Charge Code	22311179
Hospital Revenue Code	301
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Aetna of AZ Medicare	$25.48
Rate for Payer: Allwell Medicare	$14.56
Rate for Payer: Amerigroup Medicare	$14.56
Rate for Payer: APIPA Medicare/Medicaid	$33.99
Rate for Payer: AZCH Complete Medicare	$14.56
Rate for Payer: Banner UC Health Medicare	$14.56
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.88
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$59.15
Rate for Payer: Copperpoint Commercial	$22.52
Rate for Payer: Health Net of AZ Commercial	$54.60
Rate for Payer: Health Net of AZ Medicare	$25.48
Rate for Payer: Humana of AZ Medicare	$14.56
Rate for Payer: Self Pay Self Pay	$72.80
Rate for Payer: TriWest Medicare	$14.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.38

BUN/Creat Ratio

Facility

IP

$64.00

Service Code	CPT 84520
Hospital Charge Code	22146068
Hospital Revenue Code	301
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Cash Price	$51.20
Rate for Payer: Self Pay Self Pay	$51.20

BUN/Creat Ratio

Facility

OP

$64.00

Service Code	CPT 84520
Hospital Charge Code	22146068
Hospital Revenue Code	301
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of AZ Commercial	$57.60
Rate for Payer: Aetna of AZ Medicare	$17.92
Rate for Payer: Allwell Medicare	$10.24
Rate for Payer: Amerigroup Medicare	$10.24
Rate for Payer: APIPA Medicare/Medicaid	$23.90
Rate for Payer: AZCH Complete Medicare	$10.24
Rate for Payer: Banner UC Health Medicare	$10.24
Rate for Payer: Bisbee Police All Plans	$16.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.52
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cigna of AZ Commercial	$41.60
Rate for Payer: Copperpoint Commercial	$15.84
Rate for Payer: Health Net of AZ Commercial	$38.40
Rate for Payer: Health Net of AZ Medicare	$17.92
Rate for Payer: Humana of AZ Medicare	$10.24
Rate for Payer: Self Pay Self Pay	$51.20
Rate for Payer: TriWest Medicare	$10.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.52

bupivacaine 0.5% PF Inj Sol 30 mL [CQCH]

Facility

OP

$0.06

Service Code	NDC 409116202
Hospital Charge Code	105913448
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	$0.02
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	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.04
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Copperpoint Commercial	$0.01
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	$0.05
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

bupivacaine 0.5% PF Inj Sol 30 mL [CQCH]

Facility

IP

$0.06

Service Code	NDC 409116202
Hospital Charge Code	105913448
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: Self Pay Self Pay	$0.05

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