Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$5,028.34

Service Code	APR-DRG 4223
Hospital Charge Code	APRDRG4222
Min. Negotiated Rate	$5,028.34
Max. Negotiated Rate	$5,028.34
Rate for Payer: AHCCCS Medicaid	$5,028.34
Rate for Payer: Allwell Medicaid	$5,028.34
Rate for Payer: AZCH Complete Medicaid	$5,028.34
Rate for Payer: Banner UC Health Medicaid	$5,028.34
Rate for Payer: Mercy Care Medicaid	$5,028.34

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$10,095.25

Service Code	APR-DRG 4224
Hospital Charge Code	APRDRG4221
Min. Negotiated Rate	$10,095.25
Max. Negotiated Rate	$10,095.25
Rate for Payer: AHCCCS Medicaid	$10,095.25
Rate for Payer: Allwell Medicaid	$10,095.25
Rate for Payer: AZCH Complete Medicaid	$10,095.25
Rate for Payer: Banner UC Health Medicaid	$10,095.25
Rate for Payer: Mercy Care Medicaid	$10,095.25

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$3,302.19

Service Code	APR-DRG 4222
Hospital Charge Code	APRDRG4221
Min. Negotiated Rate	$3,302.19
Max. Negotiated Rate	$3,302.19
Rate for Payer: AHCCCS Medicaid	$3,302.19
Rate for Payer: Allwell Medicaid	$3,302.19
Rate for Payer: AZCH Complete Medicaid	$3,302.19
Rate for Payer: Banner UC Health Medicaid	$3,302.19
Rate for Payer: Mercy Care Medicaid	$3,302.19

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$10,095.25

Service Code	APR-DRG 4224
Hospital Charge Code	APRDRG4223
Min. Negotiated Rate	$10,095.25
Max. Negotiated Rate	$10,095.25
Rate for Payer: AHCCCS Medicaid	$10,095.25
Rate for Payer: Allwell Medicaid	$10,095.25
Rate for Payer: AZCH Complete Medicaid	$10,095.25
Rate for Payer: Banner UC Health Medicaid	$10,095.25
Rate for Payer: Mercy Care Medicaid	$10,095.25

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$5,028.34

Service Code	APR-DRG 4223
Hospital Charge Code	APRDRG4223
Min. Negotiated Rate	$5,028.34
Max. Negotiated Rate	$5,028.34
Rate for Payer: AHCCCS Medicaid	$5,028.34
Rate for Payer: Allwell Medicaid	$5,028.34
Rate for Payer: AZCH Complete Medicaid	$5,028.34
Rate for Payer: Banner UC Health Medicaid	$5,028.34
Rate for Payer: Mercy Care Medicaid	$5,028.34

Hypovolemia And Related Electrolyte Disorders

Facility

IP

$5,028.34

Service Code	APR-DRG 4223
Hospital Charge Code	APRDRG4224
Min. Negotiated Rate	$5,028.34
Max. Negotiated Rate	$5,028.34
Rate for Payer: AHCCCS Medicaid	$5,028.34
Rate for Payer: Allwell Medicaid	$5,028.34
Rate for Payer: AZCH Complete Medicaid	$5,028.34
Rate for Payer: Banner UC Health Medicaid	$5,028.34
Rate for Payer: Mercy Care Medicaid	$5,028.34

Hysteroscopy diagnostic

Facility

IP

$824.00

Service Code	CPT 58555
Hospital Charge Code	27267836
Hospital Revenue Code	360
Min. Negotiated Rate	$214.24
Max. Negotiated Rate	$741.60
Rate for Payer: Aetna of AZ Commercial	$741.60
Rate for Payer: Bisbee Police All Plans	$214.24
Rate for Payer: Cash Price	$659.20
Rate for Payer: Self Pay Self Pay	$659.20

Hysteroscopy diagnostic

Facility

OP

$824.00

Service Code	CPT 58555
Hospital Charge Code	27267836
Hospital Revenue Code	360
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$3,803.66
Rate for Payer: Aetna of AZ Commercial	$741.60
Rate for Payer: Aetna of AZ Medicare	$230.72
Rate for Payer: AHCCCS Medicaid	$3,803.66
Rate for Payer: Allwell Medicaid	$3,803.66
Rate for Payer: Allwell Medicare	$123.60
Rate for Payer: Amerigroup Medicare	$123.60
Rate for Payer: APIPA Medicare/Medicaid	$307.76
Rate for Payer: AZCH Complete Medicaid	$3,803.66
Rate for Payer: AZCH Complete Medicare	$123.60
Rate for Payer: Banner UC Health Medicaid	$3,803.66
Rate for Payer: Banner UC Health Medicare	$123.60
Rate for Payer: Bisbee Police All Plans	$214.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$560.32
Rate for Payer: Cash Price	$659.20
Rate for Payer: Cash Price	$659.20
Rate for Payer: Cigna of AZ Commercial	$412.00
Rate for Payer: Copperpoint Commercial	$203.94
Rate for Payer: Health Net of AZ Commercial	$494.40
Rate for Payer: Health Net of AZ Medicare	$230.72
Rate for Payer: Humana of AZ Medicare	$123.60
Rate for Payer: Mercy Care Medicaid	$3,803.66
Rate for Payer: Self Pay Self Pay	$659.20
Rate for Payer: TriWest Medicare	$123.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$148.32

ibuprofen 100 mg/5 mL Oral Susp [CQCH]

Facility

IP

$0.12

Service Code	NDC 50383058407
Hospital Charge Code	105926316
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.09
Rate for Payer: Self Pay Self Pay	$0.10

ibuprofen 100 mg/5 mL Oral Susp [CQCH]

Facility

OP

$0.12

Service Code	NDC 50383058407
Hospital Charge Code	105926316
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.11
Rate for Payer: Aetna of AZ Commercial	$0.11
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.04
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.08
Rate for Payer: Cash Price	$0.09
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.07
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

ibuprofen 400 mg Tab [CQCH]

Facility

OP

$0.05

Service Code	NDC 63739067210
Hospital Charge Code	105926513
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	$0.01
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	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.04
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

ibuprofen 400 mg Tab [CQCH]

Facility

IP

$0.05

Service Code	NDC 63739067210
Hospital Charge Code	105926513
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: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

ibuprofen 600 mg Tab [CQCH]

Facility

IP

$0.06

Service Code	NDC 904585461
Hospital Charge Code	105926448
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

ibuprofen 600 mg Tab [CQCH]

Facility

OP

$0.06

Service Code	NDC 904585461
Hospital Charge Code	105926448
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

ibuprofen 800 mg Tab [CQCH]

Facility

OP

$0.08

Service Code	NDC 63739069110
Hospital Charge Code	105926383
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
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	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.05
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
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	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

ibuprofen 800 mg Tab [CQCH]

Facility

IP

$0.08

Service Code	NDC 63739069110
Hospital Charge Code	105926383
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of AZ Commercial	$0.07
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.06

IFE and PE, Random Urine LC

Facility

IP

$950.00

Service Code	CPT 86335
Hospital Charge Code	1285723
Hospital Revenue Code	302
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna of AZ Commercial	$855.00
Rate for Payer: Bisbee Police All Plans	$247.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Self Pay Self Pay	$760.00

IFE and PE, Random Urine LC

Facility

OP

$950.00

Service Code	CPT 86335
Hospital Charge Code	1285723
Hospital Revenue Code	302
Min. Negotiated Rate	$29.35
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna of AZ Commercial	$855.00
Rate for Payer: Aetna of AZ Medicare	$266.00
Rate for Payer: AHCCCS Medicaid	$29.35
Rate for Payer: Allwell Medicaid	$29.35
Rate for Payer: Allwell Medicare	$142.50
Rate for Payer: Amerigroup Medicare	$142.50
Rate for Payer: APIPA Medicare/Medicaid	$354.82
Rate for Payer: AZCH Complete Medicaid	$29.35
Rate for Payer: AZCH Complete Medicare	$142.50
Rate for Payer: Banner UC Health Medicaid	$29.35
Rate for Payer: Banner UC Health Medicare	$142.50
Rate for Payer: Bisbee Police All Plans	$247.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$646.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cigna of AZ Commercial	$617.50
Rate for Payer: Copperpoint Commercial	$235.12
Rate for Payer: Health Net of AZ Commercial	$570.00
Rate for Payer: Health Net of AZ Medicare	$266.00
Rate for Payer: Humana of AZ Medicare	$142.50
Rate for Payer: Mercy Care Medicaid	$29.35
Rate for Payer: Self Pay Self Pay	$760.00
Rate for Payer: TriWest Medicare	$142.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$553.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$171.00

IFE and PE, Serum LC

Facility

IP

$717.00

Service Code	CPT 84165
Hospital Charge Code	1905770
Hospital Revenue Code	302
Min. Negotiated Rate	$186.42
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Cash Price	$573.60
Rate for Payer: Self Pay Self Pay	$573.60

IFE and PE, Serum LC

Facility

OP

$717.00

Service Code	CPT 84165
Hospital Charge Code	1905770
Hospital Revenue Code	302
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Aetna of AZ Medicare	$200.76
Rate for Payer: AHCCCS Medicaid	$10.74
Rate for Payer: Allwell Medicaid	$10.74
Rate for Payer: Allwell Medicare	$107.55
Rate for Payer: Amerigroup Medicare	$107.55
Rate for Payer: APIPA Medicare/Medicaid	$267.80
Rate for Payer: AZCH Complete Medicaid	$10.74
Rate for Payer: AZCH Complete Medicare	$107.55
Rate for Payer: Banner UC Health Medicaid	$10.74
Rate for Payer: Banner UC Health Medicare	$107.55
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$487.56
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cigna of AZ Commercial	$466.05
Rate for Payer: Copperpoint Commercial	$177.46
Rate for Payer: Health Net of AZ Commercial	$430.20
Rate for Payer: Health Net of AZ Medicare	$200.76
Rate for Payer: Humana of AZ Medicare	$107.55
Rate for Payer: Mercy Care Medicaid	$10.74
Rate for Payer: Self Pay Self Pay	$573.60
Rate for Payer: TriWest Medicare	$107.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$418.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.06

IFE+Protein Electro, 24-Hr Ur LC

Facility

OP

$950.00

Service Code	CPT 86335
Hospital Charge Code	1285722
Hospital Revenue Code	302
Min. Negotiated Rate	$29.35
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna of AZ Commercial	$855.00
Rate for Payer: Aetna of AZ Medicare	$266.00
Rate for Payer: AHCCCS Medicaid	$29.35
Rate for Payer: Allwell Medicaid	$29.35
Rate for Payer: Allwell Medicare	$142.50
Rate for Payer: Amerigroup Medicare	$142.50
Rate for Payer: APIPA Medicare/Medicaid	$354.82
Rate for Payer: AZCH Complete Medicaid	$29.35
Rate for Payer: AZCH Complete Medicare	$142.50
Rate for Payer: Banner UC Health Medicaid	$29.35
Rate for Payer: Banner UC Health Medicare	$142.50
Rate for Payer: Bisbee Police All Plans	$247.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$646.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cigna of AZ Commercial	$617.50
Rate for Payer: Copperpoint Commercial	$235.12
Rate for Payer: Health Net of AZ Commercial	$570.00
Rate for Payer: Health Net of AZ Medicare	$266.00
Rate for Payer: Humana of AZ Medicare	$142.50
Rate for Payer: Mercy Care Medicaid	$29.35
Rate for Payer: Self Pay Self Pay	$760.00
Rate for Payer: TriWest Medicare	$142.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$553.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$171.00

IFE+Protein Electro, 24-Hr Ur LC

Facility

IP

$950.00

Service Code	CPT 86335
Hospital Charge Code	1285722
Hospital Revenue Code	302
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna of AZ Commercial	$855.00
Rate for Payer: Bisbee Police All Plans	$247.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Self Pay Self Pay	$760.00

I-GEL 1

Facility

IP

$60.00

Hospital Charge Code	22926453
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

I-GEL 1

Facility

OP

$60.00

Hospital Charge Code	22926453
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

I-GEL 2

Facility

OP

$60.00

Hospital Charge Code	22926454
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

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