Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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

$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

$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

$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

$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	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

$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

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	$0.62
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna of AZ Commercial	$3.51
Rate for Payer: Aetna of AZ Medicare	$1.09
Rate for Payer: Allwell Medicare	$0.62
Rate for Payer: Amerigroup Medicare	$0.62
Rate for Payer: APIPA Medicare/Medicaid	$1.46
Rate for Payer: AZCH Complete Medicare	$0.62
Rate for Payer: Banner UC Health Medicare	$0.62
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: 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	$0.62
Rate for Payer: Self Pay Self Pay	$3.12
Rate for Payer: TriWest Medicare	$0.62
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.70

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 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	$1.44
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	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.37
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
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	$1.44
Rate for Payer: Self Pay Self Pay	$7.21
Rate for Payer: TriWest Medicare	$1.44
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	$0.05
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	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.11
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
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: 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	$0.05
Rate for Payer: Self Pay Self Pay	$0.23
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

Progesterone LC

Facility

OP

$544.00

Service Code	CPT 84144
Hospital Charge Code	1909537
Hospital Revenue Code	301
Min. Negotiated Rate	$87.04
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Aetna of AZ Medicare	$152.32
Rate for Payer: Allwell Medicare	$87.04
Rate for Payer: Amerigroup Medicare	$87.04
Rate for Payer: APIPA Medicare/Medicaid	$203.18
Rate for Payer: AZCH Complete Medicare	$87.04
Rate for Payer: Banner UC Health Medicare	$87.04
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$369.92
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cigna of AZ Commercial	$353.60
Rate for Payer: Copperpoint Commercial	$134.64
Rate for Payer: Health Net of AZ Commercial	$326.40
Rate for Payer: Health Net of AZ Medicare	$152.32
Rate for Payer: Humana of AZ Medicare	$87.04
Rate for Payer: Self Pay Self Pay	$435.20
Rate for Payer: TriWest Medicare	$87.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$317.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.92

Progesterone LC

Facility

IP

$544.00

Service Code	CPT 84144
Hospital Charge Code	1909537
Hospital Revenue Code	301
Min. Negotiated Rate	$141.44
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Cash Price	$435.20
Rate for Payer: Self Pay Self Pay	$435.20

Programming State II

Facility

OP

$210.00

Service Code	CPT 95972
Hospital Charge Code	27281906
Hospital Revenue Code	360
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of AZ Commercial	$189.00
Rate for Payer: Aetna of AZ Medicare	$58.80
Rate for Payer: AHCCCS Medicaid	$72.72
Rate for Payer: Allwell Medicaid	$72.72
Rate for Payer: Allwell Medicare	$33.60
Rate for Payer: Amerigroup Medicare	$33.60
Rate for Payer: APIPA Medicare/Medicaid	$78.44
Rate for Payer: AZCH Complete Medicaid	$72.72
Rate for Payer: AZCH Complete Medicare	$33.60
Rate for Payer: Banner UC Health Medicaid	$72.72
Rate for Payer: Banner UC Health Medicare	$33.60
Rate for Payer: Bisbee Police All Plans	$54.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$142.80
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cigna of AZ Commercial	$105.00
Rate for Payer: Copperpoint Commercial	$51.98
Rate for Payer: Health Net of AZ Commercial	$126.00
Rate for Payer: Health Net of AZ Medicare	$58.80
Rate for Payer: Humana of AZ Medicare	$33.60
Rate for Payer: Mercy Care Medicaid	$72.72
Rate for Payer: Self Pay Self Pay	$168.00
Rate for Payer: TriWest Medicare	$33.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$122.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.80

Programming State II

Facility

IP

$210.00

Service Code	CPT 95972
Hospital Charge Code	27281906
Hospital Revenue Code	360
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna of AZ Commercial	$189.00
Rate for Payer: Bisbee Police All Plans	$54.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Self Pay Self Pay	$168.00

PROINSULIN

Facility

OP

$125.00

Service Code	CPT 84206
Hospital Charge Code	22576579
Hospital Revenue Code	301
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Aetna of AZ Medicare	$35.00
Rate for Payer: Allwell Medicare	$20.00
Rate for Payer: Amerigroup Medicare	$20.00
Rate for Payer: APIPA Medicare/Medicaid	$46.69
Rate for Payer: AZCH Complete Medicare	$20.00
Rate for Payer: Banner UC Health Medicare	$20.00
Rate for Payer: Bisbee Police All Plans	$32.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$85.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cigna of AZ Commercial	$81.25
Rate for Payer: Copperpoint Commercial	$30.94
Rate for Payer: Health Net of AZ Commercial	$75.00
Rate for Payer: Health Net of AZ Medicare	$35.00
Rate for Payer: Humana of AZ Medicare	$20.00
Rate for Payer: Self Pay Self Pay	$100.00
Rate for Payer: TriWest Medicare	$20.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$72.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$22.50

PROINSULIN

Facility

IP

$125.00

Service Code	CPT 84206
Hospital Charge Code	22576579
Hospital Revenue Code	301
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of AZ Commercial	$112.50
Rate for Payer: Bisbee Police All Plans	$32.50
Rate for Payer: Cash Price	$100.00
Rate for Payer: Self Pay Self Pay	$100.00

Prolactin LC

Facility

IP

$240.00

Service Code	CPT 84146
Hospital Charge Code	1285574
Hospital Revenue Code	301
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna of AZ Commercial	$216.00
Rate for Payer: Bisbee Police All Plans	$62.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Self Pay Self Pay	$192.00

Prolactin LC

Facility

OP

$240.00

Service Code	CPT 84146
Hospital Charge Code	1285574
Hospital Revenue Code	301
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna of AZ Commercial	$216.00
Rate for Payer: Aetna of AZ Medicare	$67.20
Rate for Payer: Allwell Medicare	$38.40
Rate for Payer: Amerigroup Medicare	$38.40
Rate for Payer: APIPA Medicare/Medicaid	$89.64
Rate for Payer: AZCH Complete Medicare	$38.40
Rate for Payer: Banner UC Health Medicare	$38.40
Rate for Payer: Bisbee Police All Plans	$62.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$163.20
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cigna of AZ Commercial	$156.00
Rate for Payer: Copperpoint Commercial	$59.40
Rate for Payer: Health Net of AZ Commercial	$144.00
Rate for Payer: Health Net of AZ Medicare	$67.20
Rate for Payer: Humana of AZ Medicare	$38.40
Rate for Payer: Self Pay Self Pay	$192.00
Rate for Payer: TriWest Medicare	$38.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.20

promethazine 25 mg/ 1mL Inj Sol [CQCH]

Facility

IP

$0.84

Service Code	HCPCS J2550
Hospital Charge Code	105938466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Cash Price	$0.67
Rate for Payer: Self Pay Self Pay	$0.67

promethazine 25 mg/ 1mL Inj Sol [CQCH]

Facility

OP

$0.84

Service Code	HCPCS J2550
Hospital Charge Code	105938466
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.76
Rate for Payer: Aetna of AZ Commercial	$0.76
Rate for Payer: Aetna of AZ Medicare	$0.24
Rate for Payer: Allwell Medicare	$0.13
Rate for Payer: Amerigroup Medicare	$0.13
Rate for Payer: APIPA Medicare/Medicaid	$0.31
Rate for Payer: AZCH Complete Medicare	$0.13
Rate for Payer: Banner UC Health Medicare	$0.13
Rate for Payer: Bisbee Police All Plans	$0.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.57
Rate for Payer: Cash Price	$0.67
Rate for Payer: Cigna of AZ Commercial	$0.55
Rate for Payer: Copperpoint Commercial	$0.21
Rate for Payer: Health Net of AZ Commercial	$0.50
Rate for Payer: Health Net of AZ Medicare	$0.24
Rate for Payer: Humana of AZ Medicare	$0.13
Rate for Payer: Self Pay Self Pay	$0.67
Rate for Payer: TriWest Medicare	$0.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.15

promethazine 25 mg Supp [CQCH]

Facility

OP

$3.03

Service Code	NDC 45802075930
Hospital Charge Code	105938401
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.73
Rate for Payer: Aetna of AZ Commercial	$2.73
Rate for Payer: Aetna of AZ Medicare	$0.85
Rate for Payer: Allwell Medicare	$0.48
Rate for Payer: Amerigroup Medicare	$0.48
Rate for Payer: APIPA Medicare/Medicaid	$1.13
Rate for Payer: AZCH Complete Medicare	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Bisbee Police All Plans	$0.79
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.06
Rate for Payer: Cash Price	$2.42
Rate for Payer: Cigna of AZ Commercial	$1.97
Rate for Payer: Copperpoint Commercial	$0.75
Rate for Payer: Health Net of AZ Commercial	$1.82
Rate for Payer: Health Net of AZ Medicare	$0.85
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Self Pay Self Pay	$2.42
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.55

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