Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00
Rate for Payer: NaphCare Correctional Healthcare	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67
Rate for Payer: NaphCare Correctional Healthcare	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67
Rate for Payer: NaphCare Correctional Healthcare	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$21,425.67

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$21,425.67
Max. Negotiated Rate	$21,425.67
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$21,425.67
Rate for Payer: Mercy Care Medicaid	$21,425.67
Rate for Payer: NaphCare Correctional Healthcare	$21,425.67

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6614
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00
Rate for Payer: NaphCare Correctional Healthcare	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07
Rate for Payer: NaphCare Correctional Healthcare	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$7,162.00

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$7,162.00
Max. Negotiated Rate	$7,162.00
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,162.00
Rate for Payer: Mercy Care Medicaid	$7,162.00
Rate for Payer: NaphCare Correctional Healthcare	$7,162.00

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6611
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48
Rate for Payer: NaphCare Correctional Healthcare	$5,502.48

Coagulation And Platelet Disorders

Facility

IP

$10,455.07

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG6613
Min. Negotiated Rate	$10,455.07
Max. Negotiated Rate	$10,455.07
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,455.07
Rate for Payer: Mercy Care Medicaid	$10,455.07
Rate for Payer: NaphCare Correctional Healthcare	$10,455.07

Coagulation And Platelet Disorders

Facility

IP

$5,502.48

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG6612
Min. Negotiated Rate	$5,502.48
Max. Negotiated Rate	$5,502.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,502.48
Rate for Payer: Mercy Care Medicaid	$5,502.48
Rate for Payer: NaphCare Correctional Healthcare	$5,502.48

COAGULATION DISORDERS

Facility

IP

$19,713.20

Service Code	MSDRG 813
Min. Negotiated Rate	$19,713.20
Max. Negotiated Rate	$19,713.20
Rate for Payer: Seven Corners Travel Insurance	$19,713.20

coagulation factor IX recombinant Kit[CQCH]

Facility

IP

$3,060.00

Service Code	HCPCS J7195
Hospital Charge Code	244006072
Hospital Revenue Code	250
Min. Negotiated Rate	$2,754.00
Max. Negotiated Rate	$2,754.00
Rate for Payer: Aetna of AZ Commercial	$2,754.00
Rate for Payer: Cash Price	$2,448.00

coagulation factor IX recombinant Kit[CQCH]

Facility

OP

$3,060.00

Service Code	HCPCS J7195
Hospital Charge Code	244006072
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2,754.00
Rate for Payer: Aetna of AZ Commercial	$2,754.00
Rate for Payer: Arizona Complete Health Allwell	$489.60
Rate for Payer: Banner UC Health Medicare	$489.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,080.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$489.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$489.60
Rate for Payer: Cash Price	$2,448.00
Rate for Payer: Cash Price	$2,448.00
Rate for Payer: Cigna of AZ Commercial	$1,989.00
Rate for Payer: Devoted Health Medicare	$550.80
Rate for Payer: Humana of AZ Medicare	$489.60
Rate for Payer: Seven Corners Travel Insurance	$2.70
Rate for Payer: Southwest Service Administrators UFCW	$2,080.80
Rate for Payer: TriWest Medicare	$489.60
Rate for Payer: United Healthcare Commercial	$1,750.32
Rate for Payer: United Healthcare Medicare	$489.60
Rate for Payer: Veterans Affairs TRICARE	$484.70

.Cobalt, Comment LC

Facility

IP

$268.00

Service Code	CPT 83018
Hospital Charge Code	22311139
Hospital Revenue Code	302
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Cash Price	$214.40

.Cobalt, Comment LC

Facility

OP

$268.00

Service Code	CPT 83018
Hospital Charge Code	22311139
Hospital Revenue Code	302
Min. Negotiated Rate	$31.84
Max. Negotiated Rate	$241.20
Rate for Payer: Aetna of AZ Commercial	$241.20
Rate for Payer: Arizona Complete Health Allwell	$42.88
Rate for Payer: Banner UC Health Medicare	$42.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$182.24
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.88
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cigna of AZ Commercial	$174.20
Rate for Payer: Devoted Health Medicare	$48.24
Rate for Payer: Humana of AZ Medicare	$42.88
Rate for Payer: Seven Corners Travel Insurance	$31.84
Rate for Payer: Southwest Service Administrators UFCW	$182.24
Rate for Payer: TriWest Medicare	$42.88
Rate for Payer: United Healthcare Commercial	$153.30
Rate for Payer: United Healthcare Medicare	$42.88
Rate for Payer: Veterans Affairs TRICARE	$42.45

Cobalt LC

Facility

IP

$255.00

Service Code	CPT 83018
Hospital Charge Code	6738683
Hospital Revenue Code	301
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Cash Price	$204.00

Cobalt LC

Facility

OP

$255.00

Service Code	CPT 83018
Hospital Charge Code	6738683
Hospital Revenue Code	301
Min. Negotiated Rate	$31.84
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Arizona Complete Health Allwell	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$173.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$40.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$40.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Devoted Health Medicare	$45.90
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Seven Corners Travel Insurance	$31.84
Rate for Payer: Southwest Service Administrators UFCW	$173.40
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: United Healthcare Commercial	$145.86
Rate for Payer: United Healthcare Medicare	$40.80
Rate for Payer: Veterans Affairs TRICARE	$40.39

Cobalt, Urine LC

Facility

OP

$238.00

Service Code	CPT 83018
Hospital Charge Code	22311184
Hospital Revenue Code	301
Min. Negotiated Rate	$31.84
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Arizona Complete Health Allwell	$38.08
Rate for Payer: Banner UC Health Medicare	$38.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$161.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$38.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$38.08
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$154.70
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Humana of AZ Medicare	$38.08
Rate for Payer: Seven Corners Travel Insurance	$31.84
Rate for Payer: Southwest Service Administrators UFCW	$161.84
Rate for Payer: TriWest Medicare	$38.08
Rate for Payer: United Healthcare Commercial	$136.14
Rate for Payer: United Healthcare Medicare	$38.08
Rate for Payer: Veterans Affairs TRICARE	$37.70

Cobalt, Urine LC

Facility

IP

$238.00

Service Code	CPT 83018
Hospital Charge Code	22311184
Hospital Revenue Code	301
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Cash Price	$190.40

Cocaine Abuse And Dependence

Facility

IP

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06
Rate for Payer: NaphCare Correctional Healthcare	$2,586.06

Cocaine Abuse And Dependence

Facility

IP

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7742
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25
Rate for Payer: NaphCare Correctional Healthcare	$2,327.25

Cocaine Abuse And Dependence

Facility

IP

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25
Rate for Payer: NaphCare Correctional Healthcare	$2,327.25

Cocaine Abuse And Dependence

Facility

IP

$2,327.25

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG7743
Min. Negotiated Rate	$2,327.25
Max. Negotiated Rate	$2,327.25
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,327.25
Rate for Payer: Mercy Care Medicaid	$2,327.25
Rate for Payer: NaphCare Correctional Healthcare	$2,327.25

Cocaine Abuse And Dependence

Facility

IP

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7741
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06
Rate for Payer: NaphCare Correctional Healthcare	$2,586.06

Cocaine Abuse And Dependence

Facility

IP

$2,586.06

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG7744
Min. Negotiated Rate	$2,586.06
Max. Negotiated Rate	$2,586.06
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$2,586.06
Rate for Payer: Mercy Care Medicaid	$2,586.06
Rate for Payer: NaphCare Correctional Healthcare	$2,586.06

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