Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Burns With Skin Graft Except Extensive Third Degree Burns

Facility

IP

$10,090.34

Service Code	APR-DRG 8421
Hospital Charge Code	APRDRG8424
Min. Negotiated Rate	$10,090.34
Max. Negotiated Rate	$10,090.34
Rate for Payer: AHCCCS Medicaid	$10,090.34
Rate for Payer: Allwell Medicaid	$10,090.34
Rate for Payer: AZCH Complete Medicaid	$10,090.34
Rate for Payer: Banner UC Health Medicaid	$10,090.34
Rate for Payer: Mercy Care Medicaid	$10,090.34

Burns With Skin Graft Except Extensive Third Degree Burns

Facility

IP

$71,693.60

Service Code	APR-DRG 8424
Hospital Charge Code	APRDRG8421
Min. Negotiated Rate	$71,693.60
Max. Negotiated Rate	$71,693.60
Rate for Payer: AHCCCS Medicaid	$71,693.60
Rate for Payer: Allwell Medicaid	$71,693.60
Rate for Payer: AZCH Complete Medicaid	$71,693.60
Rate for Payer: Banner UC Health Medicaid	$71,693.60
Rate for Payer: Mercy Care Medicaid	$71,693.60

Burns With Skin Graft Except Extensive Third Degree Burns

Facility

IP

$15,824.99

Service Code	APR-DRG 8422
Hospital Charge Code	APRDRG8421
Min. Negotiated Rate	$15,824.99
Max. Negotiated Rate	$15,824.99
Rate for Payer: AHCCCS Medicaid	$15,824.99
Rate for Payer: Allwell Medicaid	$15,824.99
Rate for Payer: AZCH Complete Medicaid	$15,824.99
Rate for Payer: Banner UC Health Medicaid	$15,824.99
Rate for Payer: Mercy Care Medicaid	$15,824.99

Burns With Skin Graft Except Extensive Third Degree Burns

Facility

IP

$10,090.34

Service Code	APR-DRG 8421
Hospital Charge Code	APRDRG8421
Min. Negotiated Rate	$10,090.34
Max. Negotiated Rate	$10,090.34
Rate for Payer: AHCCCS Medicaid	$10,090.34
Rate for Payer: Allwell Medicaid	$10,090.34
Rate for Payer: AZCH Complete Medicaid	$10,090.34
Rate for Payer: Banner UC Health Medicaid	$10,090.34
Rate for Payer: Mercy Care Medicaid	$10,090.34

Burns With Skin Graft Except Extensive Third Degree Burns

Facility

IP

$71,693.60

Service Code	APR-DRG 8424
Hospital Charge Code	APRDRG8423
Min. Negotiated Rate	$71,693.60
Max. Negotiated Rate	$71,693.60
Rate for Payer: AHCCCS Medicaid	$71,693.60
Rate for Payer: Allwell Medicaid	$71,693.60
Rate for Payer: AZCH Complete Medicaid	$71,693.60
Rate for Payer: Banner UC Health Medicaid	$71,693.60
Rate for Payer: Mercy Care Medicaid	$71,693.60

busPIRone 5 mg Tab [CQCH]

Facility

IP

$0.02

Service Code	NDC 64380074108
Hospital Charge Code	105913714
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

busPIRone 5 mg Tab [CQCH]

Facility

OP

$0.02

Service Code	NDC 64380074108
Hospital Charge Code	105913714
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

butorphanol 1 mg/mL Inj Sol [CQCH]

Facility

OP

$3.53

Service Code	HCPCS J0595
Hospital Charge Code	105913781
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$3.18
Rate for Payer: Aetna of AZ Commercial	$3.18
Rate for Payer: Aetna of AZ Medicare	$0.99
Rate for Payer: Allwell Medicare	$0.56
Rate for Payer: Amerigroup Medicare	$0.56
Rate for Payer: APIPA Medicare/Medicaid	$1.32
Rate for Payer: AZCH Complete Medicare	$0.56
Rate for Payer: Banner UC Health Medicare	$0.56
Rate for Payer: Bisbee Police All Plans	$0.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.40
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cigna of AZ Commercial	$2.29
Rate for Payer: Copperpoint Commercial	$0.87
Rate for Payer: Health Net of AZ Commercial	$2.12
Rate for Payer: Health Net of AZ Medicare	$0.99
Rate for Payer: Humana of AZ Medicare	$0.56
Rate for Payer: Self Pay Self Pay	$2.82
Rate for Payer: TriWest Medicare	$0.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.64

butorphanol 1 mg/mL Inj Sol [CQCH]

Facility

IP

$3.53

Service Code	HCPCS J0595
Hospital Charge Code	105913781
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$3.18
Rate for Payer: Aetna of AZ Commercial	$3.18
Rate for Payer: Bisbee Police All Plans	$0.92
Rate for Payer: Cash Price	$2.82
Rate for Payer: Self Pay Self Pay	$2.82

butorphanol 2 mg/mL Sol[CQCH]

Facility

IP

$4.73

Service Code	HCPCS J0595
Hospital Charge Code	133556199
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$4.26
Rate for Payer: Aetna of AZ Commercial	$4.26
Rate for Payer: Bisbee Police All Plans	$1.23
Rate for Payer: Cash Price	$3.78
Rate for Payer: Self Pay Self Pay	$3.78

butorphanol 2 mg/mL Sol[CQCH]

Facility

OP

$4.73

Service Code	HCPCS J0595
Hospital Charge Code	133556199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$4.26
Rate for Payer: Aetna of AZ Commercial	$4.26
Rate for Payer: Aetna of AZ Medicare	$1.32
Rate for Payer: Allwell Medicare	$0.76
Rate for Payer: Amerigroup Medicare	$0.76
Rate for Payer: APIPA Medicare/Medicaid	$1.77
Rate for Payer: AZCH Complete Medicare	$0.76
Rate for Payer: Banner UC Health Medicare	$0.76
Rate for Payer: Bisbee Police All Plans	$1.23
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.22
Rate for Payer: Cash Price	$3.78
Rate for Payer: Cigna of AZ Commercial	$3.07
Rate for Payer: Copperpoint Commercial	$1.17
Rate for Payer: Health Net of AZ Commercial	$2.84
Rate for Payer: Health Net of AZ Medicare	$1.32
Rate for Payer: Humana of AZ Medicare	$0.76
Rate for Payer: Self Pay Self Pay	$3.78
Rate for Payer: TriWest Medicare	$0.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.85

CA 15-3 (Serial Monitor) LC

Facility

IP

$250.00

Service Code	CPT 86300
Hospital Charge Code	22311180
Hospital Revenue Code	302
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Bisbee Police All Plans	$65.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Self Pay Self Pay	$200.00

CA 15-3 (Serial Monitor) LC

Facility

OP

$250.00

Service Code	CPT 86300
Hospital Charge Code	22311180
Hospital Revenue Code	302
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna of AZ Commercial	$225.00
Rate for Payer: Aetna of AZ Medicare	$70.00
Rate for Payer: Allwell Medicare	$40.00
Rate for Payer: Amerigroup Medicare	$40.00
Rate for Payer: APIPA Medicare/Medicaid	$93.38
Rate for Payer: AZCH Complete Medicare	$40.00
Rate for Payer: Banner UC Health Medicare	$40.00
Rate for Payer: Bisbee Police All Plans	$65.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$170.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna of AZ Commercial	$162.50
Rate for Payer: Copperpoint Commercial	$61.88
Rate for Payer: Health Net of AZ Commercial	$150.00
Rate for Payer: Health Net of AZ Medicare	$70.00
Rate for Payer: Humana of AZ Medicare	$40.00
Rate for Payer: Self Pay Self Pay	$200.00
Rate for Payer: TriWest Medicare	$40.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$145.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.00

CA 27.29 LC

Facility

IP

$276.00

Service Code	CPT 86300
Hospital Charge Code	2270021
Hospital Revenue Code	302
Min. Negotiated Rate	$71.76
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Bisbee Police All Plans	$71.76
Rate for Payer: Cash Price	$220.80
Rate for Payer: Self Pay Self Pay	$220.80

CA 27.29 LC

Facility

OP

$276.00

Service Code	CPT 86300
Hospital Charge Code	2270021
Hospital Revenue Code	302
Min. Negotiated Rate	$44.16
Max. Negotiated Rate	$248.40
Rate for Payer: Aetna of AZ Commercial	$248.40
Rate for Payer: Aetna of AZ Medicare	$77.28
Rate for Payer: Allwell Medicare	$44.16
Rate for Payer: Amerigroup Medicare	$44.16
Rate for Payer: APIPA Medicare/Medicaid	$103.09
Rate for Payer: AZCH Complete Medicare	$44.16
Rate for Payer: Banner UC Health Medicare	$44.16
Rate for Payer: Bisbee Police All Plans	$71.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$187.68
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cigna of AZ Commercial	$179.40
Rate for Payer: Copperpoint Commercial	$68.31
Rate for Payer: Health Net of AZ Commercial	$165.60
Rate for Payer: Health Net of AZ Medicare	$77.28
Rate for Payer: Humana of AZ Medicare	$44.16
Rate for Payer: Self Pay Self Pay	$220.80
Rate for Payer: TriWest Medicare	$44.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$160.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$49.68

calcitonin 200 intl units/inh Nasal Spry [CQCH]

Facility

OP

$9.43

Service Code	NDC 60505082306
Hospital Charge Code	105913923
Hospital Revenue Code	251
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$8.49
Rate for Payer: Aetna of AZ Commercial	$8.49
Rate for Payer: Aetna of AZ Medicare	$2.64
Rate for Payer: Allwell Medicare	$1.51
Rate for Payer: Amerigroup Medicare	$1.51
Rate for Payer: APIPA Medicare/Medicaid	$3.52
Rate for Payer: AZCH Complete Medicare	$1.51
Rate for Payer: Banner UC Health Medicare	$1.51
Rate for Payer: Bisbee Police All Plans	$2.45
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.41
Rate for Payer: Cash Price	$7.54
Rate for Payer: Cigna of AZ Commercial	$6.13
Rate for Payer: Copperpoint Commercial	$2.33
Rate for Payer: Health Net of AZ Commercial	$5.66
Rate for Payer: Health Net of AZ Medicare	$2.64
Rate for Payer: Humana of AZ Medicare	$1.51
Rate for Payer: Self Pay Self Pay	$7.54
Rate for Payer: TriWest Medicare	$1.51
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.70

calcitonin 200 intl units/inh Nasal Spry [CQCH]

Facility

IP

$9.43

Service Code	NDC 60505082306
Hospital Charge Code	105913923
Hospital Revenue Code	251
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$8.49
Rate for Payer: Aetna of AZ Commercial	$8.49
Rate for Payer: Bisbee Police All Plans	$2.45
Rate for Payer: Cash Price	$7.54
Rate for Payer: Self Pay Self Pay	$7.54

calcitonin 200 intl units/mL Inj Sol [CQCH]

Facility

IP

$480.12

Service Code	HCPCS J0630
Hospital Charge Code	105913850
Hospital Revenue Code	250
Min. Negotiated Rate	$124.83
Max. Negotiated Rate	$432.11
Rate for Payer: Aetna of AZ Commercial	$432.11
Rate for Payer: Bisbee Police All Plans	$124.83
Rate for Payer: Cash Price	$384.09
Rate for Payer: Self Pay Self Pay	$384.10

calcitonin 200 intl units/mL Inj Sol [CQCH]

Facility

OP

$480.12

Service Code	HCPCS J0630
Hospital Charge Code	105913850
Hospital Revenue Code	250
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$432.11
Rate for Payer: Aetna of AZ Commercial	$432.11
Rate for Payer: Aetna of AZ Medicare	$134.43
Rate for Payer: Allwell Medicare	$76.82
Rate for Payer: Amerigroup Medicare	$76.82
Rate for Payer: APIPA Medicare/Medicaid	$179.32
Rate for Payer: AZCH Complete Medicare	$76.82
Rate for Payer: Banner UC Health Medicare	$76.82
Rate for Payer: Bisbee Police All Plans	$124.83
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$326.48
Rate for Payer: Cash Price	$384.09
Rate for Payer: Cigna of AZ Commercial	$312.08
Rate for Payer: Copperpoint Commercial	$118.83
Rate for Payer: Health Net of AZ Commercial	$288.07
Rate for Payer: Health Net of AZ Medicare	$134.43
Rate for Payer: Humana of AZ Medicare	$76.82
Rate for Payer: Self Pay Self Pay	$384.10
Rate for Payer: TriWest Medicare	$76.82
Rate for Payer: UnitedHealth Group of AZ Commercial	$279.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.42

calcitriol 0.25 mcg Oral Cap [CQCH]

Facility

IP

$0.56

Service Code	NDC 60687034501
Hospital Charge Code	105913988
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of AZ Commercial	$0.50
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Cash Price	$0.45
Rate for Payer: Self Pay Self Pay	$0.45

calcitriol 0.25 mcg Oral Cap [CQCH]

Facility

OP

$0.56

Service Code	NDC 60687034501
Hospital Charge Code	105913988
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of AZ Commercial	$0.50
Rate for Payer: Aetna of AZ Medicare	$0.16
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.21
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.38
Rate for Payer: Cash Price	$0.45
Rate for Payer: Cigna of AZ Commercial	$0.36
Rate for Payer: Copperpoint Commercial	$0.14
Rate for Payer: Health Net of AZ Commercial	$0.34
Rate for Payer: Health Net of AZ Medicare	$0.16
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Self Pay Self Pay	$0.45
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.10

Calcitriol(1,25 di-OH Vit D) LC

Facility

IP

$540.00

Service Code	CPT 82652
Hospital Charge Code	1905607
Hospital Revenue Code	301
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna of AZ Commercial	$486.00
Rate for Payer: Bisbee Police All Plans	$140.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Self Pay Self Pay	$432.00

Calcitriol(1,25 di-OH Vit D) LC

Facility

OP

$540.00

Service Code	CPT 82652
Hospital Charge Code	1905607
Hospital Revenue Code	301
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna of AZ Commercial	$486.00
Rate for Payer: Aetna of AZ Medicare	$151.20
Rate for Payer: Allwell Medicare	$86.40
Rate for Payer: Amerigroup Medicare	$86.40
Rate for Payer: APIPA Medicare/Medicaid	$201.69
Rate for Payer: AZCH Complete Medicare	$86.40
Rate for Payer: Banner UC Health Medicare	$86.40
Rate for Payer: Bisbee Police All Plans	$140.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$367.20
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna of AZ Commercial	$351.00
Rate for Payer: Copperpoint Commercial	$133.65
Rate for Payer: Health Net of AZ Commercial	$324.00
Rate for Payer: Health Net of AZ Medicare	$151.20
Rate for Payer: Humana of AZ Medicare	$86.40
Rate for Payer: Self Pay Self Pay	$432.00
Rate for Payer: TriWest Medicare	$86.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$314.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.20

Calcium, 24Hr Urine LC

Facility

OP

$74.00

Service Code	CPT 82340
Hospital Charge Code	1285720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Aetna of AZ Medicare	$20.72
Rate for Payer: Allwell Medicare	$11.84
Rate for Payer: Amerigroup Medicare	$11.84
Rate for Payer: APIPA Medicare/Medicaid	$27.64
Rate for Payer: AZCH Complete Medicare	$11.84
Rate for Payer: Banner UC Health Medicare	$11.84
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$50.32
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cigna of AZ Commercial	$48.10
Rate for Payer: Copperpoint Commercial	$18.32
Rate for Payer: Health Net of AZ Commercial	$44.40
Rate for Payer: Health Net of AZ Medicare	$20.72
Rate for Payer: Humana of AZ Medicare	$11.84
Rate for Payer: Self Pay Self Pay	$59.20
Rate for Payer: TriWest Medicare	$11.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.32

Calcium, 24Hr Urine LC

Facility

IP

$74.00

Service Code	CPT 82340
Hospital Charge Code	1285720
Hospital Revenue Code	301
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$66.60
Rate for Payer: Aetna of AZ Commercial	$66.60
Rate for Payer: Bisbee Police All Plans	$19.24
Rate for Payer: Cash Price	$59.20
Rate for Payer: Self Pay Self Pay	$59.20

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