Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [CQCH]

Facility

OP

$0.16

Service Code	NDC 71205090960
Hospital Charge Code	105912306
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.11
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.09
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

atropine-diphenoxylate 0.025 mg-2.5 mg Tab [CQCH]

Facility

IP

$0.16

Service Code	NDC 71205090960
Hospital Charge Code	105912306
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Cash Price	$0.13

atropine Ophth 1% Sol [CQCH]

Facility

OP

$44.74

Service Code	NDC 65030355
Hospital Charge Code	105912175
Hospital Revenue Code	251
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna of AZ Commercial	$40.27
Rate for Payer: Arizona Complete Health Allwell	$7.16
Rate for Payer: Banner UC Health Medicare	$7.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$30.42
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.16
Rate for Payer: Cash Price	$35.79
Rate for Payer: Cigna of AZ Commercial	$29.08
Rate for Payer: Devoted Health Medicare	$8.05
Rate for Payer: Humana of AZ Medicare	$7.16
Rate for Payer: Southwest Service Administrators UFCW	$30.42
Rate for Payer: TriWest Medicare	$7.16
Rate for Payer: United Healthcare Commercial	$25.59
Rate for Payer: United Healthcare Medicare	$7.16
Rate for Payer: Veterans Affairs TRICARE	$7.09

atropine Ophth 1% Sol [CQCH]

Facility

IP

$44.74

Service Code	NDC 65030355
Hospital Charge Code	105912175
Hospital Revenue Code	251
Min. Negotiated Rate	$40.27
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna of AZ Commercial	$40.27
Rate for Payer: Cash Price	$35.79

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$62,166.48

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG0084
Min. Negotiated Rate	$62,166.48
Max. Negotiated Rate	$62,166.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48
Rate for Payer: NaphCare Correctional Healthcare	$62,166.48

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$62,166.48

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG0082
Min. Negotiated Rate	$62,166.48
Max. Negotiated Rate	$62,166.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48
Rate for Payer: NaphCare Correctional Healthcare	$62,166.48

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$33,226.72

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG0082
Min. Negotiated Rate	$33,226.72
Max. Negotiated Rate	$33,226.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72
Rate for Payer: NaphCare Correctional Healthcare	$33,226.72

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: Blue Cross Blue Shield of Arizona Health Choice	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72
Rate for Payer: NaphCare Correctional Healthcare	$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: Blue Cross Blue Shield of Arizona Health Choice	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26
Rate for Payer: NaphCare Correctional Healthcare	$27,684.26

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: Blue Cross Blue Shield of Arizona Health Choice	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26
Rate for Payer: NaphCare Correctional Healthcare	$27,684.26

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$38,943.83

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG0084
Min. Negotiated Rate	$38,943.83
Max. Negotiated Rate	$38,943.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,943.83
Rate for Payer: Mercy Care Medicaid	$38,943.83
Rate for Payer: NaphCare Correctional Healthcare	$38,943.83

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: Blue Cross Blue Shield of Arizona Health Choice	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48
Rate for Payer: NaphCare Correctional Healthcare	$62,166.48

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$38,943.83

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG0083
Min. Negotiated Rate	$38,943.83
Max. Negotiated Rate	$38,943.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,943.83
Rate for Payer: Mercy Care Medicaid	$38,943.83
Rate for Payer: NaphCare Correctional Healthcare	$38,943.83

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$27,684.26

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG0082
Min. Negotiated Rate	$27,684.26
Max. Negotiated Rate	$27,684.26
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26
Rate for Payer: NaphCare Correctional Healthcare	$27,684.26

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$62,166.48

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG0083
Min. Negotiated Rate	$62,166.48
Max. Negotiated Rate	$62,166.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$62,166.48
Rate for Payer: Mercy Care Medicaid	$62,166.48
Rate for Payer: NaphCare Correctional Healthcare	$62,166.48

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$33,226.72

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG0081
Min. Negotiated Rate	$33,226.72
Max. Negotiated Rate	$33,226.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$33,226.72
Rate for Payer: Mercy Care Medicaid	$33,226.72
Rate for Payer: NaphCare Correctional Healthcare	$33,226.72

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: Blue Cross Blue Shield of Arizona Health Choice	$38,943.83
Rate for Payer: Mercy Care Medicaid	$38,943.83
Rate for Payer: NaphCare Correctional Healthcare	$38,943.83

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$38,943.83

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG0082
Min. Negotiated Rate	$38,943.83
Max. Negotiated Rate	$38,943.83
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$38,943.83
Rate for Payer: Mercy Care Medicaid	$38,943.83
Rate for Payer: NaphCare Correctional Healthcare	$38,943.83

Autologous Bone Marrow Transplant Or T-Cell Immunotherapy

Facility

IP

$27,684.26

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG0083
Min. Negotiated Rate	$27,684.26
Max. Negotiated Rate	$27,684.26
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,684.26
Rate for Payer: Mercy Care Medicaid	$27,684.26
Rate for Payer: NaphCare Correctional Healthcare	$27,684.26

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

IP

$76,636.28

Service Code	MSDRG 016
Min. Negotiated Rate	$76,636.28
Max. Negotiated Rate	$76,636.28
Rate for Payer: Seven Corners Travel Insurance	$76,636.28

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

IP

$70,207.80

Service Code	MSDRG 017
Min. Negotiated Rate	$70,207.80
Max. Negotiated Rate	$70,207.80
Rate for Payer: Seven Corners Travel Insurance	$70,207.80

AUX CHANNEL WATER TUBE SET

Facility

IP

$90.00

Hospital Charge Code	23640518
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Cash Price	$72.00

AUX CHANNEL WATER TUBE SET

Facility

OP

$90.00

Hospital Charge Code	23640518
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Arizona Complete Health Allwell	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$61.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$14.40
Rate for Payer: Care1st Health Plan Arizona Medicare	$14.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$63.00
Rate for Payer: Devoted Health Medicare	$16.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Southwest Service Administrators UFCW	$61.20
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: United Healthcare Commercial	$51.48
Rate for Payer: United Healthcare Medicare	$14.40
Rate for Payer: Veterans Affairs TRICARE	$14.26

AUX WATER CHANNEL ADAPTER

Facility

OP

$26.00

Hospital Charge Code	23640517
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna of AZ Commercial	$23.40
Rate for Payer: Arizona Complete Health Allwell	$4.16
Rate for Payer: Banner UC Health Medicare	$4.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$4.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$4.16
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cigna of AZ Commercial	$18.20
Rate for Payer: Devoted Health Medicare	$4.68
Rate for Payer: Humana of AZ Medicare	$4.16
Rate for Payer: Southwest Service Administrators UFCW	$17.68
Rate for Payer: TriWest Medicare	$4.16
Rate for Payer: United Healthcare Commercial	$14.87
Rate for Payer: United Healthcare Medicare	$4.16
Rate for Payer: Veterans Affairs TRICARE	$4.12

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