Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Procedures For Obesity

Facility

IP

$7,285.44

Service Code	APR-DRG 4031
Hospital Charge Code	APRDRG4033
Min. Negotiated Rate	$7,285.44
Max. Negotiated Rate	$7,285.44
Rate for Payer: AHCCCS Medicaid	$7,285.44
Rate for Payer: Allwell Medicaid	$7,285.44
Rate for Payer: AZCH Complete Medicaid	$7,285.44
Rate for Payer: Banner UC Health Medicaid	$7,285.44
Rate for Payer: Mercy Care Medicaid	$7,285.44

Procedures For Obesity

Facility

IP

$8,425.22

Service Code	APR-DRG 4032
Hospital Charge Code	APRDRG4033
Min. Negotiated Rate	$8,425.22
Max. Negotiated Rate	$8,425.22
Rate for Payer: AHCCCS Medicaid	$8,425.22
Rate for Payer: Allwell Medicaid	$8,425.22
Rate for Payer: AZCH Complete Medicaid	$8,425.22
Rate for Payer: Banner UC Health Medicaid	$8,425.22
Rate for Payer: Mercy Care Medicaid	$8,425.22

Procedures For Obesity

Facility

IP

$13,512.47

Service Code	APR-DRG 4033
Hospital Charge Code	APRDRG4032
Min. Negotiated Rate	$13,512.47
Max. Negotiated Rate	$13,512.47
Rate for Payer: AHCCCS Medicaid	$13,512.47
Rate for Payer: Allwell Medicaid	$13,512.47
Rate for Payer: AZCH Complete Medicaid	$13,512.47
Rate for Payer: Banner UC Health Medicaid	$13,512.47
Rate for Payer: Mercy Care Medicaid	$13,512.47

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$44,695.31

Service Code	APR-DRG 8504
Hospital Charge Code	APRDRG8502
Min. Negotiated Rate	$44,695.31
Max. Negotiated Rate	$44,695.31
Rate for Payer: AHCCCS Medicaid	$44,695.31
Rate for Payer: Allwell Medicaid	$44,695.31
Rate for Payer: AZCH Complete Medicaid	$44,695.31
Rate for Payer: Banner UC Health Medicaid	$44,695.31
Rate for Payer: Mercy Care Medicaid	$44,695.31

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$15,397.83

Service Code	APR-DRG 8502
Hospital Charge Code	APRDRG8502
Min. Negotiated Rate	$15,397.83
Max. Negotiated Rate	$15,397.83
Rate for Payer: AHCCCS Medicaid	$15,397.83
Rate for Payer: Allwell Medicaid	$15,397.83
Rate for Payer: AZCH Complete Medicaid	$15,397.83
Rate for Payer: Banner UC Health Medicaid	$15,397.83
Rate for Payer: Mercy Care Medicaid	$15,397.83

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$15,397.83

Service Code	APR-DRG 8502
Hospital Charge Code	APRDRG8501
Min. Negotiated Rate	$15,397.83
Max. Negotiated Rate	$15,397.83
Rate for Payer: AHCCCS Medicaid	$15,397.83
Rate for Payer: Allwell Medicaid	$15,397.83
Rate for Payer: AZCH Complete Medicaid	$15,397.83
Rate for Payer: Banner UC Health Medicaid	$15,397.83
Rate for Payer: Mercy Care Medicaid	$15,397.83

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$11,244.14

Service Code	APR-DRG 8501
Hospital Charge Code	APRDRG8504
Min. Negotiated Rate	$11,244.14
Max. Negotiated Rate	$11,244.14
Rate for Payer: AHCCCS Medicaid	$11,244.14
Rate for Payer: Allwell Medicaid	$11,244.14
Rate for Payer: AZCH Complete Medicaid	$11,244.14
Rate for Payer: Banner UC Health Medicaid	$11,244.14
Rate for Payer: Mercy Care Medicaid	$11,244.14

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$11,244.14

Service Code	APR-DRG 8501
Hospital Charge Code	APRDRG8502
Min. Negotiated Rate	$11,244.14
Max. Negotiated Rate	$11,244.14
Rate for Payer: AHCCCS Medicaid	$11,244.14
Rate for Payer: Allwell Medicaid	$11,244.14
Rate for Payer: AZCH Complete Medicaid	$11,244.14
Rate for Payer: Banner UC Health Medicaid	$11,244.14
Rate for Payer: Mercy Care Medicaid	$11,244.14

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$19,903.63

Service Code	APR-DRG 8503
Hospital Charge Code	APRDRG8503
Min. Negotiated Rate	$19,903.63
Max. Negotiated Rate	$19,903.63
Rate for Payer: AHCCCS Medicaid	$19,903.63
Rate for Payer: Allwell Medicaid	$19,903.63
Rate for Payer: AZCH Complete Medicaid	$19,903.63
Rate for Payer: Banner UC Health Medicaid	$19,903.63
Rate for Payer: Mercy Care Medicaid	$19,903.63

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$44,695.31

Service Code	APR-DRG 8504
Hospital Charge Code	APRDRG8501
Min. Negotiated Rate	$44,695.31
Max. Negotiated Rate	$44,695.31
Rate for Payer: AHCCCS Medicaid	$44,695.31
Rate for Payer: Allwell Medicaid	$44,695.31
Rate for Payer: AZCH Complete Medicaid	$44,695.31
Rate for Payer: Banner UC Health Medicaid	$44,695.31
Rate for Payer: Mercy Care Medicaid	$44,695.31

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$19,903.63

Service Code	APR-DRG 8503
Hospital Charge Code	APRDRG8502
Min. Negotiated Rate	$19,903.63
Max. Negotiated Rate	$19,903.63
Rate for Payer: AHCCCS Medicaid	$19,903.63
Rate for Payer: Allwell Medicaid	$19,903.63
Rate for Payer: AZCH Complete Medicaid	$19,903.63
Rate for Payer: Banner UC Health Medicaid	$19,903.63
Rate for Payer: Mercy Care Medicaid	$19,903.63

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$19,903.63

Service Code	APR-DRG 8503
Hospital Charge Code	APRDRG8504
Min. Negotiated Rate	$19,903.63
Max. Negotiated Rate	$19,903.63
Rate for Payer: AHCCCS Medicaid	$19,903.63
Rate for Payer: Allwell Medicaid	$19,903.63
Rate for Payer: AZCH Complete Medicaid	$19,903.63
Rate for Payer: Banner UC Health Medicaid	$19,903.63
Rate for Payer: Mercy Care Medicaid	$19,903.63

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$15,397.83

Service Code	APR-DRG 8502
Hospital Charge Code	APRDRG8503
Min. Negotiated Rate	$15,397.83
Max. Negotiated Rate	$15,397.83
Rate for Payer: AHCCCS Medicaid	$15,397.83
Rate for Payer: Allwell Medicaid	$15,397.83
Rate for Payer: AZCH Complete Medicaid	$15,397.83
Rate for Payer: Banner UC Health Medicaid	$15,397.83
Rate for Payer: Mercy Care Medicaid	$15,397.83

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$11,244.14

Service Code	APR-DRG 8501
Hospital Charge Code	APRDRG8503
Min. Negotiated Rate	$11,244.14
Max. Negotiated Rate	$11,244.14
Rate for Payer: AHCCCS Medicaid	$11,244.14
Rate for Payer: Allwell Medicaid	$11,244.14
Rate for Payer: AZCH Complete Medicaid	$11,244.14
Rate for Payer: Banner UC Health Medicaid	$11,244.14
Rate for Payer: Mercy Care Medicaid	$11,244.14

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$15,397.83

Service Code	APR-DRG 8502
Hospital Charge Code	APRDRG8504
Min. Negotiated Rate	$15,397.83
Max. Negotiated Rate	$15,397.83
Rate for Payer: AHCCCS Medicaid	$15,397.83
Rate for Payer: Allwell Medicaid	$15,397.83
Rate for Payer: AZCH Complete Medicaid	$15,397.83
Rate for Payer: Banner UC Health Medicaid	$15,397.83
Rate for Payer: Mercy Care Medicaid	$15,397.83

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$44,695.31

Service Code	APR-DRG 8504
Hospital Charge Code	APRDRG8504
Min. Negotiated Rate	$44,695.31
Max. Negotiated Rate	$44,695.31
Rate for Payer: AHCCCS Medicaid	$44,695.31
Rate for Payer: Allwell Medicaid	$44,695.31
Rate for Payer: AZCH Complete Medicaid	$44,695.31
Rate for Payer: Banner UC Health Medicaid	$44,695.31
Rate for Payer: Mercy Care Medicaid	$44,695.31

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$19,903.63

Service Code	APR-DRG 8503
Hospital Charge Code	APRDRG8501
Min. Negotiated Rate	$19,903.63
Max. Negotiated Rate	$19,903.63
Rate for Payer: AHCCCS Medicaid	$19,903.63
Rate for Payer: Allwell Medicaid	$19,903.63
Rate for Payer: AZCH Complete Medicaid	$19,903.63
Rate for Payer: Banner UC Health Medicaid	$19,903.63
Rate for Payer: Mercy Care Medicaid	$19,903.63

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$44,695.31

Service Code	APR-DRG 8504
Hospital Charge Code	APRDRG8503
Min. Negotiated Rate	$44,695.31
Max. Negotiated Rate	$44,695.31
Rate for Payer: AHCCCS Medicaid	$44,695.31
Rate for Payer: Allwell Medicaid	$44,695.31
Rate for Payer: AZCH Complete Medicaid	$44,695.31
Rate for Payer: Banner UC Health Medicaid	$44,695.31
Rate for Payer: Mercy Care Medicaid	$44,695.31

Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services

Facility

IP

$11,244.14

Service Code	APR-DRG 8501
Hospital Charge Code	APRDRG8501
Min. Negotiated Rate	$11,244.14
Max. Negotiated Rate	$11,244.14
Rate for Payer: AHCCCS Medicaid	$11,244.14
Rate for Payer: Allwell Medicaid	$11,244.14
Rate for Payer: AZCH Complete Medicaid	$11,244.14
Rate for Payer: Banner UC Health Medicaid	$11,244.14
Rate for Payer: Mercy Care Medicaid	$11,244.14

prochlorperazine 10 mg/2 mL Inj Sol [CQCH]

Facility

IP

$3.90

Service Code	HCPCS J0780
Hospital Charge Code	105952781
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna of AZ Commercial	$3.51
Rate for Payer: Bisbee Police All Plans	$1.01
Rate for Payer: Cash Price	$3.12
Rate for Payer: Self Pay Self Pay	$3.12

prochlorperazine 10 mg/2 mL Inj Sol [CQCH]

Facility

OP

$3.90

Service Code	HCPCS J0780
Hospital Charge Code	105952781
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna of AZ Commercial	$3.51
Rate for Payer: Aetna of AZ Medicare	$1.09
Rate for Payer: AHCCCS Medicaid	$5.60
Rate for Payer: Allwell Medicaid	$5.60
Rate for Payer: Allwell Medicare	$0.59
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: APIPA Medicare/Medicaid	$1.46
Rate for Payer: AZCH Complete Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$0.59
Rate for Payer: Banner UC Health Medicaid	$5.60
Rate for Payer: Banner UC Health Medicare	$0.59
Rate for Payer: Bisbee Police All Plans	$1.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.65
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cigna of AZ Commercial	$2.54
Rate for Payer: Copperpoint Commercial	$0.97
Rate for Payer: Health Net of AZ Commercial	$2.34
Rate for Payer: Health Net of AZ Medicare	$1.09
Rate for Payer: Humana of AZ Medicare	$0.59
Rate for Payer: Mercy Care Medicaid	$5.60
Rate for Payer: Self Pay Self Pay	$3.12
Rate for Payer: TriWest Medicare	$0.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.70

prochlorperazine 25 mg Supp [CQCH]

Facility

IP

$9.01

Service Code	NDC 713013512
Hospital Charge Code	105938267
Hospital Revenue Code	251
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.11
Rate for Payer: Aetna of AZ Commercial	$8.11
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.21
Rate for Payer: Self Pay Self Pay	$7.21

prochlorperazine 25 mg Supp [CQCH]

Facility

OP

$9.01

Service Code	NDC 713013512
Hospital Charge Code	105938267
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$8.11
Rate for Payer: Aetna of AZ Commercial	$8.11
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.35
Rate for Payer: Amerigroup Medicare	$1.35
Rate for Payer: APIPA Medicare/Medicaid	$3.37
Rate for Payer: AZCH Complete Medicare	$1.35
Rate for Payer: Banner UC Health Medicare	$1.35
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.13
Rate for Payer: Cash Price	$7.21
Rate for Payer: Cigna of AZ Commercial	$5.86
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.41
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.35
Rate for Payer: Self Pay Self Pay	$7.21
Rate for Payer: TriWest Medicare	$1.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

prochlorperazine 5 mg Tab [CQCH]

Facility

IP

$0.29

Service Code	HCPCS Q0164
Hospital Charge Code	105938198
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	$0.23
Rate for Payer: Self Pay Self Pay	$0.23

prochlorperazine 5 mg Tab [CQCH]

Facility

OP

$0.29

Service Code	HCPCS Q0164
Hospital Charge Code	105938198
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.48
Rate for Payer: Aetna of AZ Commercial	$0.26
Rate for Payer: Aetna of AZ Medicare	$0.08
Rate for Payer: AHCCCS Medicaid	$0.48
Rate for Payer: Allwell Medicaid	$0.48
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 Medicaid	$0.48
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicaid	$0.48
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	$0.23
Rate for Payer: Cash Price	$0.23
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: Mercy Care Medicaid	$0.48
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

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