Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: AHCCCS Medicaid	$10,957.27
Rate for Payer: Allwell Medicaid	$10,957.27
Rate for Payer: AZCH Complete Medicaid	$10,957.27
Rate for Payer: Banner UC Health Medicaid	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: AHCCCS Medicaid	$16,580.39
Rate for Payer: Allwell Medicaid	$16,580.39
Rate for Payer: AZCH Complete Medicaid	$16,580.39
Rate for Payer: Banner UC Health Medicaid	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: AHCCCS Medicaid	$10,957.27
Rate for Payer: Allwell Medicaid	$10,957.27
Rate for Payer: AZCH Complete Medicaid	$10,957.27
Rate for Payer: Banner UC Health Medicaid	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: AHCCCS Medicaid	$34,134.33
Rate for Payer: Allwell Medicaid	$34,134.33
Rate for Payer: AZCH Complete Medicaid	$34,134.33
Rate for Payer: Banner UC Health Medicaid	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5104
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: AHCCCS Medicaid	$34,134.33
Rate for Payer: Allwell Medicaid	$34,134.33
Rate for Payer: AZCH Complete Medicaid	$34,134.33
Rate for Payer: Banner UC Health Medicaid	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$34,134.33

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$34,134.33
Max. Negotiated Rate	$34,134.33
Rate for Payer: AHCCCS Medicaid	$34,134.33
Rate for Payer: Allwell Medicaid	$34,134.33
Rate for Payer: AZCH Complete Medicaid	$34,134.33
Rate for Payer: Banner UC Health Medicaid	$34,134.33
Rate for Payer: Mercy Care Medicaid	$34,134.33

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: AHCCCS Medicaid	$16,580.39
Rate for Payer: Allwell Medicaid	$16,580.39
Rate for Payer: AZCH Complete Medicaid	$16,580.39
Rate for Payer: Banner UC Health Medicaid	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$10,957.27

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$10,957.27
Max. Negotiated Rate	$10,957.27
Rate for Payer: AHCCCS Medicaid	$10,957.27
Rate for Payer: Allwell Medicaid	$10,957.27
Rate for Payer: AZCH Complete Medicaid	$10,957.27
Rate for Payer: Banner UC Health Medicaid	$10,957.27
Rate for Payer: Mercy Care Medicaid	$10,957.27

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$16,580.39

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$16,580.39
Max. Negotiated Rate	$16,580.39
Rate for Payer: AHCCCS Medicaid	$16,580.39
Rate for Payer: Allwell Medicaid	$16,580.39
Rate for Payer: AZCH Complete Medicaid	$16,580.39
Rate for Payer: Banner UC Health Medicaid	$16,580.39
Rate for Payer: Mercy Care Medicaid	$16,580.39

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5103
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: AHCCCS Medicaid	$8,637.04
Rate for Payer: Allwell Medicaid	$8,637.04
Rate for Payer: AZCH Complete Medicaid	$8,637.04
Rate for Payer: Banner UC Health Medicaid	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5101
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: AHCCCS Medicaid	$8,637.04
Rate for Payer: Allwell Medicaid	$8,637.04
Rate for Payer: AZCH Complete Medicaid	$8,637.04
Rate for Payer: Banner UC Health Medicaid	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04

Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures

Facility

IP

$8,637.04

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG5102
Min. Negotiated Rate	$8,637.04
Max. Negotiated Rate	$8,637.04
Rate for Payer: AHCCCS Medicaid	$8,637.04
Rate for Payer: Allwell Medicaid	$8,637.04
Rate for Payer: AZCH Complete Medicaid	$8,637.04
Rate for Payer: Banner UC Health Medicaid	$8,637.04
Rate for Payer: Mercy Care Medicaid	$8,637.04

Pelvic exam under anesthesia

Facility

IP

$680.00

Service Code	CPT 57400
Hospital Charge Code	27291800
Hospital Revenue Code	360
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Self Pay Self Pay	$544.00

Pelvic exam under anesthesia

Facility

OP

$680.00

Service Code	CPT 57400
Hospital Charge Code	27291800
Hospital Revenue Code	360
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Aetna of AZ Medicare	$190.40
Rate for Payer: AHCCCS Medicaid	$1,901.83
Rate for Payer: Allwell Medicaid	$1,901.83
Rate for Payer: Allwell Medicare	$108.80
Rate for Payer: Amerigroup Medicare	$108.80
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicaid	$1,901.83
Rate for Payer: AZCH Complete Medicare	$108.80
Rate for Payer: Banner UC Health Medicaid	$1,901.83
Rate for Payer: Banner UC Health Medicare	$108.80
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$462.40
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$340.00
Rate for Payer: Copperpoint Commercial	$168.30
Rate for Payer: Health Net of AZ Commercial	$408.00
Rate for Payer: Health Net of AZ Medicare	$190.40
Rate for Payer: Humana of AZ Medicare	$108.80
Rate for Payer: Mercy Care Medicaid	$1,901.83
Rate for Payer: Self Pay Self Pay	$544.00
Rate for Payer: TriWest Medicare	$108.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.40

Penicillin G 5,000,000 units inj REC [CQCH]

Facility

IP

$5.48

Service Code	HCPCS J2540
Hospital Charge Code	105935952
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna of AZ Commercial	$4.93
Rate for Payer: Bisbee Police All Plans	$1.42
Rate for Payer: Cash Price	$4.38
Rate for Payer: Self Pay Self Pay	$4.38

Penicillin G 5,000,000 units inj REC [CQCH]

Facility

OP

$5.48

Service Code	HCPCS J2540
Hospital Charge Code	105935952
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna of AZ Commercial	$4.93
Rate for Payer: Aetna of AZ Medicare	$1.53
Rate for Payer: Allwell Medicare	$0.88
Rate for Payer: Amerigroup Medicare	$0.88
Rate for Payer: APIPA Medicare/Medicaid	$2.05
Rate for Payer: AZCH Complete Medicare	$0.88
Rate for Payer: Banner UC Health Medicare	$0.88
Rate for Payer: Bisbee Police All Plans	$1.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.73
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cigna of AZ Commercial	$3.56
Rate for Payer: Copperpoint Commercial	$1.36
Rate for Payer: Health Net of AZ Commercial	$3.29
Rate for Payer: Health Net of AZ Medicare	$1.53
Rate for Payer: Humana of AZ Medicare	$0.88
Rate for Payer: Self Pay Self Pay	$4.38
Rate for Payer: TriWest Medicare	$0.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.99

penicillin G benzathine 1,200,000 units/2 mL Sus [CQCH]

Facility

OP

$80.05

Service Code	HCPCS J0561
Hospital Charge Code	105935877
Hospital Revenue Code	250
Min. Negotiated Rate	$12.81
Max. Negotiated Rate	$72.05
Rate for Payer: Aetna of AZ Commercial	$72.05
Rate for Payer: Aetna of AZ Medicare	$22.41
Rate for Payer: Allwell Medicare	$12.81
Rate for Payer: Amerigroup Medicare	$12.81
Rate for Payer: APIPA Medicare/Medicaid	$29.90
Rate for Payer: AZCH Complete Medicare	$12.81
Rate for Payer: Banner UC Health Medicare	$12.81
Rate for Payer: Bisbee Police All Plans	$20.81
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.43
Rate for Payer: Cash Price	$64.04
Rate for Payer: Cigna of AZ Commercial	$52.03
Rate for Payer: Copperpoint Commercial	$19.81
Rate for Payer: Health Net of AZ Commercial	$48.03
Rate for Payer: Health Net of AZ Medicare	$22.41
Rate for Payer: Humana of AZ Medicare	$12.81
Rate for Payer: Self Pay Self Pay	$64.04
Rate for Payer: TriWest Medicare	$12.81
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.41

penicillin G benzathine 1,200,000 units/2 mL Sus [CQCH]

Facility

IP

$80.05

Service Code	HCPCS J0561
Hospital Charge Code	105935877
Hospital Revenue Code	250
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$72.05
Rate for Payer: Aetna of AZ Commercial	$72.05
Rate for Payer: Bisbee Police All Plans	$20.81
Rate for Payer: Cash Price	$64.04
Rate for Payer: Self Pay Self Pay	$64.04

Penicillin VK 250 mg Tab [CQCH]

Facility

IP

$0.08

Service Code	NDC 57237004001
Hospital Charge Code	105936021
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	$0.06
Rate for Payer: Self Pay Self Pay	$0.06

Penicillin VK 250 mg Tab [CQCH]

Facility

OP

$0.08

Service Code	NDC 57237004001
Hospital Charge Code	105936021
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	$0.06
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

Penis, Testes And Scrotal Procedures

Facility

IP

$9,340.54

Service Code	APR-DRG 4832
Hospital Charge Code	APRDRG4834
Min. Negotiated Rate	$9,340.54
Max. Negotiated Rate	$9,340.54
Rate for Payer: AHCCCS Medicaid	$9,340.54
Rate for Payer: Allwell Medicaid	$9,340.54
Rate for Payer: AZCH Complete Medicaid	$9,340.54
Rate for Payer: Banner UC Health Medicaid	$9,340.54
Rate for Payer: Mercy Care Medicaid	$9,340.54

Penis, Testes And Scrotal Procedures

Facility

IP

$24,699.10

Service Code	APR-DRG 4834
Hospital Charge Code	APRDRG4834
Min. Negotiated Rate	$24,699.10
Max. Negotiated Rate	$24,699.10
Rate for Payer: AHCCCS Medicaid	$24,699.10
Rate for Payer: Allwell Medicaid	$24,699.10
Rate for Payer: AZCH Complete Medicaid	$24,699.10
Rate for Payer: Banner UC Health Medicaid	$24,699.10
Rate for Payer: Mercy Care Medicaid	$24,699.10

Penis, Testes And Scrotal Procedures

Facility

IP

$9,340.54

Service Code	APR-DRG 4832
Hospital Charge Code	APRDRG4831
Min. Negotiated Rate	$9,340.54
Max. Negotiated Rate	$9,340.54
Rate for Payer: AHCCCS Medicaid	$9,340.54
Rate for Payer: Allwell Medicaid	$9,340.54
Rate for Payer: AZCH Complete Medicaid	$9,340.54
Rate for Payer: Banner UC Health Medicaid	$9,340.54
Rate for Payer: Mercy Care Medicaid	$9,340.54

Penis, Testes And Scrotal Procedures

Facility

IP

$13,713.07

Service Code	APR-DRG 4833
Hospital Charge Code	APRDRG4834
Min. Negotiated Rate	$13,713.07
Max. Negotiated Rate	$13,713.07
Rate for Payer: AHCCCS Medicaid	$13,713.07
Rate for Payer: Allwell Medicaid	$13,713.07
Rate for Payer: AZCH Complete Medicaid	$13,713.07
Rate for Payer: Banner UC Health Medicaid	$13,713.07
Rate for Payer: Mercy Care Medicaid	$13,713.07

Penis, Testes And Scrotal Procedures

Facility

IP

$13,713.07

Service Code	APR-DRG 4833
Hospital Charge Code	APRDRG4832
Min. Negotiated Rate	$13,713.07
Max. Negotiated Rate	$13,713.07
Rate for Payer: AHCCCS Medicaid	$13,713.07
Rate for Payer: Allwell Medicaid	$13,713.07
Rate for Payer: AZCH Complete Medicaid	$13,713.07
Rate for Payer: Banner UC Health Medicaid	$13,713.07
Rate for Payer: Mercy Care Medicaid	$13,713.07

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