Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$5,973.12

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG5173
Min. Negotiated Rate	$5,973.12
Max. Negotiated Rate	$5,973.12
Rate for Payer: AHCCCS Medicaid	$5,973.12
Rate for Payer: Allwell Medicaid	$5,973.12
Rate for Payer: AZCH Complete Medicaid	$5,973.12
Rate for Payer: Banner UC Health Medicaid	$5,973.12
Rate for Payer: Mercy Care Medicaid	$5,973.12

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$4,712.71

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG5172
Min. Negotiated Rate	$4,712.71
Max. Negotiated Rate	$4,712.71
Rate for Payer: AHCCCS Medicaid	$4,712.71
Rate for Payer: Allwell Medicaid	$4,712.71
Rate for Payer: AZCH Complete Medicaid	$4,712.71
Rate for Payer: Banner UC Health Medicaid	$4,712.71
Rate for Payer: Mercy Care Medicaid	$4,712.71

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$25,133.27

Service Code	APR-DRG 5174
Hospital Charge Code	APRDRG5173
Min. Negotiated Rate	$25,133.27
Max. Negotiated Rate	$25,133.27
Rate for Payer: AHCCCS Medicaid	$25,133.27
Rate for Payer: Allwell Medicaid	$25,133.27
Rate for Payer: AZCH Complete Medicaid	$25,133.27
Rate for Payer: Banner UC Health Medicaid	$25,133.27
Rate for Payer: Mercy Care Medicaid	$25,133.27

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$4,712.71

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG5173
Min. Negotiated Rate	$4,712.71
Max. Negotiated Rate	$4,712.71
Rate for Payer: AHCCCS Medicaid	$4,712.71
Rate for Payer: Allwell Medicaid	$4,712.71
Rate for Payer: AZCH Complete Medicaid	$4,712.71
Rate for Payer: Banner UC Health Medicaid	$4,712.71
Rate for Payer: Mercy Care Medicaid	$4,712.71

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$5,973.12

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG5174
Min. Negotiated Rate	$5,973.12
Max. Negotiated Rate	$5,973.12
Rate for Payer: AHCCCS Medicaid	$5,973.12
Rate for Payer: Allwell Medicaid	$5,973.12
Rate for Payer: AZCH Complete Medicaid	$5,973.12
Rate for Payer: Banner UC Health Medicaid	$5,973.12
Rate for Payer: Mercy Care Medicaid	$5,973.12

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$10,337.23

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG5172
Min. Negotiated Rate	$10,337.23
Max. Negotiated Rate	$10,337.23
Rate for Payer: AHCCCS Medicaid	$10,337.23
Rate for Payer: Allwell Medicaid	$10,337.23
Rate for Payer: AZCH Complete Medicaid	$10,337.23
Rate for Payer: Banner UC Health Medicaid	$10,337.23
Rate for Payer: Mercy Care Medicaid	$10,337.23

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$4,712.71

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG5171
Min. Negotiated Rate	$4,712.71
Max. Negotiated Rate	$4,712.71
Rate for Payer: AHCCCS Medicaid	$4,712.71
Rate for Payer: Allwell Medicaid	$4,712.71
Rate for Payer: AZCH Complete Medicaid	$4,712.71
Rate for Payer: Banner UC Health Medicaid	$4,712.71
Rate for Payer: Mercy Care Medicaid	$4,712.71

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$25,133.27

Service Code	APR-DRG 5174
Hospital Charge Code	APRDRG5174
Min. Negotiated Rate	$25,133.27
Max. Negotiated Rate	$25,133.27
Rate for Payer: AHCCCS Medicaid	$25,133.27
Rate for Payer: Allwell Medicaid	$25,133.27
Rate for Payer: AZCH Complete Medicaid	$25,133.27
Rate for Payer: Banner UC Health Medicaid	$25,133.27
Rate for Payer: Mercy Care Medicaid	$25,133.27

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$10,337.23

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG5171
Min. Negotiated Rate	$10,337.23
Max. Negotiated Rate	$10,337.23
Rate for Payer: AHCCCS Medicaid	$10,337.23
Rate for Payer: Allwell Medicaid	$10,337.23
Rate for Payer: AZCH Complete Medicaid	$10,337.23
Rate for Payer: Banner UC Health Medicaid	$10,337.23
Rate for Payer: Mercy Care Medicaid	$10,337.23

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$25,133.27

Service Code	APR-DRG 5174
Hospital Charge Code	APRDRG5171
Min. Negotiated Rate	$25,133.27
Max. Negotiated Rate	$25,133.27
Rate for Payer: AHCCCS Medicaid	$25,133.27
Rate for Payer: Allwell Medicaid	$25,133.27
Rate for Payer: AZCH Complete Medicaid	$25,133.27
Rate for Payer: Banner UC Health Medicaid	$25,133.27
Rate for Payer: Mercy Care Medicaid	$25,133.27

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$10,337.23

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG5174
Min. Negotiated Rate	$10,337.23
Max. Negotiated Rate	$10,337.23
Rate for Payer: AHCCCS Medicaid	$10,337.23
Rate for Payer: Allwell Medicaid	$10,337.23
Rate for Payer: AZCH Complete Medicaid	$10,337.23
Rate for Payer: Banner UC Health Medicaid	$10,337.23
Rate for Payer: Mercy Care Medicaid	$10,337.23

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$5,973.12

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG5172
Min. Negotiated Rate	$5,973.12
Max. Negotiated Rate	$5,973.12
Rate for Payer: AHCCCS Medicaid	$5,973.12
Rate for Payer: Allwell Medicaid	$5,973.12
Rate for Payer: AZCH Complete Medicaid	$5,973.12
Rate for Payer: Banner UC Health Medicaid	$5,973.12
Rate for Payer: Mercy Care Medicaid	$5,973.12

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$5,973.12

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG5171
Min. Negotiated Rate	$5,973.12
Max. Negotiated Rate	$5,973.12
Rate for Payer: AHCCCS Medicaid	$5,973.12
Rate for Payer: Allwell Medicaid	$5,973.12
Rate for Payer: AZCH Complete Medicaid	$5,973.12
Rate for Payer: Banner UC Health Medicaid	$5,973.12
Rate for Payer: Mercy Care Medicaid	$5,973.12

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$10,337.23

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG5173
Min. Negotiated Rate	$10,337.23
Max. Negotiated Rate	$10,337.23
Rate for Payer: AHCCCS Medicaid	$10,337.23
Rate for Payer: Allwell Medicaid	$10,337.23
Rate for Payer: AZCH Complete Medicaid	$10,337.23
Rate for Payer: Banner UC Health Medicaid	$10,337.23
Rate for Payer: Mercy Care Medicaid	$10,337.23

Dilation And Curettage For Non-Obstetric Diagnoses

Facility

IP

$4,712.71

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG5174
Min. Negotiated Rate	$4,712.71
Max. Negotiated Rate	$4,712.71
Rate for Payer: AHCCCS Medicaid	$4,712.71
Rate for Payer: Allwell Medicaid	$4,712.71
Rate for Payer: AZCH Complete Medicaid	$4,712.71
Rate for Payer: Banner UC Health Medicaid	$4,712.71
Rate for Payer: Mercy Care Medicaid	$4,712.71

DILATOR URETERAL 6X4 BALLOON

Facility

IP

$802.00

Hospital Charge Code	22354207
Hospital Revenue Code	270
Min. Negotiated Rate	$208.52
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Cash Price	$641.60
Rate for Payer: Self Pay Self Pay	$641.60

DILATOR URETERAL 6X4 BALLOON

Facility

OP

$802.00

Hospital Charge Code	22354207
Hospital Revenue Code	270
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Aetna of AZ Medicare	$224.56
Rate for Payer: Allwell Medicare	$120.30
Rate for Payer: Amerigroup Medicare	$120.30
Rate for Payer: APIPA Medicare/Medicaid	$299.55
Rate for Payer: AZCH Complete Medicare	$120.30
Rate for Payer: Banner UC Health Medicare	$120.30
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$545.36
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cigna of AZ Commercial	$561.40
Rate for Payer: Copperpoint Commercial	$198.50
Rate for Payer: Health Net of AZ Commercial	$481.20
Rate for Payer: Health Net of AZ Medicare	$224.56
Rate for Payer: Humana of AZ Medicare	$120.30
Rate for Payer: Self Pay Self Pay	$641.60
Rate for Payer: TriWest Medicare	$120.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$467.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.36

dilTIAZem 100 mg IV Inj (ADD-Vantage) [CQCH]

Facility

OP

$10.71

Service Code	NDC 409435003
Hospital Charge Code	105919232
Hospital Revenue Code	251
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$9.64
Rate for Payer: Aetna of AZ Commercial	$9.64
Rate for Payer: Aetna of AZ Medicare	$3.00
Rate for Payer: Allwell Medicare	$1.61
Rate for Payer: Amerigroup Medicare	$1.61
Rate for Payer: APIPA Medicare/Medicaid	$4.00
Rate for Payer: AZCH Complete Medicare	$1.61
Rate for Payer: Banner UC Health Medicare	$1.61
Rate for Payer: Bisbee Police All Plans	$2.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$7.28
Rate for Payer: Cash Price	$8.56
Rate for Payer: Cigna of AZ Commercial	$6.96
Rate for Payer: Copperpoint Commercial	$2.65
Rate for Payer: Health Net of AZ Commercial	$6.43
Rate for Payer: Health Net of AZ Medicare	$3.00
Rate for Payer: Humana of AZ Medicare	$1.61
Rate for Payer: Self Pay Self Pay	$8.57
Rate for Payer: TriWest Medicare	$1.61
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.93

dilTIAZem 100 mg IV Inj (ADD-Vantage) [CQCH]

Facility

IP

$10.71

Service Code	NDC 409435003
Hospital Charge Code	105919232
Hospital Revenue Code	251
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$9.64
Rate for Payer: Aetna of AZ Commercial	$9.64
Rate for Payer: Bisbee Police All Plans	$2.78
Rate for Payer: Cash Price	$8.56
Rate for Payer: Self Pay Self Pay	$8.57

dilTIAZem 120 mg ER Cap [CQCH]

Facility

IP

$0.28

Service Code	NDC 60687019501
Hospital Charge Code	105919102
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	$0.23
Rate for Payer: Self Pay Self Pay	$0.22

dilTIAZem 120 mg ER Cap [CQCH]

Facility

OP

$0.28

Service Code	NDC 60687019501
Hospital Charge Code	105919102
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	$0.23
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

dilTIAZem 125 mg/ 25 ml Sol [CQCH]

Facility

OP

$0.41

Service Code	NDC 17478093725
Hospital Charge Code	108382261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Aetna of AZ Medicare	$0.11
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.15
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.28
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.25
Rate for Payer: Health Net of AZ Medicare	$0.11
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.33
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.07

dilTIAZem 125 mg/ 25 ml Sol [CQCH]

Facility

IP

$0.41

Service Code	NDC 17478093725
Hospital Charge Code	108382261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of AZ Commercial	$0.37
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.32
Rate for Payer: Self Pay Self Pay	$0.33

dilTIAZem 180 mg ER Cap [CQCH]

Facility

OP

$0.29

Service Code	NDC 63739001510
Hospital Charge Code	105919167
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
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	$0.11
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.20
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of AZ Commercial	$0.19
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	$0.23
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

dilTIAZem 180 mg ER Cap [CQCH]

Facility

IP

$0.29

Service Code	NDC 63739001510
Hospital Charge Code	105919167
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Bisbee Police All Plans	$0.08
Rate for Payer: Cash Price	$0.24
Rate for Payer: Self Pay Self Pay	$0.23

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