Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$3,375.84

Service Code	APR-DRG 2791
Hospital Charge Code	APRDRG2794
Min. Negotiated Rate	$3,375.84
Max. Negotiated Rate	$3,375.84
Rate for Payer: AHCCCS Medicaid	$3,375.84
Rate for Payer: Allwell Medicaid	$3,375.84
Rate for Payer: AZCH Complete Medicaid	$3,375.84
Rate for Payer: Banner UC Health Medicaid	$3,375.84
Rate for Payer: Mercy Care Medicaid	$3,375.84

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$3,375.84

Service Code	APR-DRG 2791
Hospital Charge Code	APRDRG2792
Min. Negotiated Rate	$3,375.84
Max. Negotiated Rate	$3,375.84
Rate for Payer: AHCCCS Medicaid	$3,375.84
Rate for Payer: Allwell Medicaid	$3,375.84
Rate for Payer: AZCH Complete Medicaid	$3,375.84
Rate for Payer: Banner UC Health Medicaid	$3,375.84
Rate for Payer: Mercy Care Medicaid	$3,375.84

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$6,830.93

Service Code	APR-DRG 2793
Hospital Charge Code	APRDRG2791
Min. Negotiated Rate	$6,830.93
Max. Negotiated Rate	$6,830.93
Rate for Payer: AHCCCS Medicaid	$6,830.93
Rate for Payer: Allwell Medicaid	$6,830.93
Rate for Payer: AZCH Complete Medicaid	$6,830.93
Rate for Payer: Banner UC Health Medicaid	$6,830.93
Rate for Payer: Mercy Care Medicaid	$6,830.93

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$16,093.62

Service Code	APR-DRG 2794
Hospital Charge Code	APRDRG2792
Min. Negotiated Rate	$16,093.62
Max. Negotiated Rate	$16,093.62
Rate for Payer: AHCCCS Medicaid	$16,093.62
Rate for Payer: Allwell Medicaid	$16,093.62
Rate for Payer: AZCH Complete Medicaid	$16,093.62
Rate for Payer: Banner UC Health Medicaid	$16,093.62
Rate for Payer: Mercy Care Medicaid	$16,093.62

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$6,830.93

Service Code	APR-DRG 2793
Hospital Charge Code	APRDRG2794
Min. Negotiated Rate	$6,830.93
Max. Negotiated Rate	$6,830.93
Rate for Payer: AHCCCS Medicaid	$6,830.93
Rate for Payer: Allwell Medicaid	$6,830.93
Rate for Payer: AZCH Complete Medicaid	$6,830.93
Rate for Payer: Banner UC Health Medicaid	$6,830.93
Rate for Payer: Mercy Care Medicaid	$6,830.93

Hepatic Function Panel Standard

Facility

OP

$198.00

Service Code	CPT 80076
Hospital Charge Code	22141045
Hospital Revenue Code	301
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of AZ Commercial	$178.20
Rate for Payer: Aetna of AZ Medicare	$55.44
Rate for Payer: Allwell Medicare	$31.68
Rate for Payer: Amerigroup Medicare	$31.68
Rate for Payer: APIPA Medicare/Medicaid	$73.95
Rate for Payer: AZCH Complete Medicare	$31.68
Rate for Payer: Banner UC Health Medicare	$31.68
Rate for Payer: Bisbee Police All Plans	$51.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$134.64
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cigna of AZ Commercial	$128.70
Rate for Payer: Copperpoint Commercial	$49.01
Rate for Payer: Health Net of AZ Commercial	$118.80
Rate for Payer: Health Net of AZ Medicare	$55.44
Rate for Payer: Humana of AZ Medicare	$31.68
Rate for Payer: Self Pay Self Pay	$158.40
Rate for Payer: TriWest Medicare	$31.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$115.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.64

Hepatic Function Panel Standard

Facility

IP

$198.00

Service Code	CPT 80076
Hospital Charge Code	22141045
Hospital Revenue Code	301
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of AZ Commercial	$178.20
Rate for Payer: Bisbee Police All Plans	$51.48
Rate for Payer: Cash Price	$158.40
Rate for Payer: Self Pay Self Pay	$158.40

hepatitis A adult vaccine 1440 units/mL preservative free Sus[CQCH]

Facility

IP

$63.32

Service Code	NDC 58160082652
Hospital Charge Code	147577806
Hospital Revenue Code	250
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna of AZ Commercial	$56.99
Rate for Payer: Bisbee Police All Plans	$16.46
Rate for Payer: Cash Price	$50.66
Rate for Payer: Self Pay Self Pay	$50.66

hepatitis A adult vaccine 1440 units/mL preservative free Sus[CQCH]

Facility

OP

$63.32

Service Code	NDC 58160082652
Hospital Charge Code	147577806
Hospital Revenue Code	250
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna of AZ Commercial	$56.99
Rate for Payer: Aetna of AZ Medicare	$17.73
Rate for Payer: Allwell Medicare	$10.13
Rate for Payer: Amerigroup Medicare	$10.13
Rate for Payer: APIPA Medicare/Medicaid	$23.65
Rate for Payer: AZCH Complete Medicare	$10.13
Rate for Payer: Banner UC Health Medicare	$10.13
Rate for Payer: Bisbee Police All Plans	$16.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$43.06
Rate for Payer: Cash Price	$50.66
Rate for Payer: Cigna of AZ Commercial	$41.16
Rate for Payer: Copperpoint Commercial	$15.67
Rate for Payer: Health Net of AZ Commercial	$37.99
Rate for Payer: Health Net of AZ Medicare	$17.73
Rate for Payer: Humana of AZ Medicare	$10.13
Rate for Payer: Self Pay Self Pay	$50.66
Rate for Payer: TriWest Medicare	$10.13
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.40

hepatitis B adult vaccine 20 mcg [CQCH]

Facility

IP

$48.20

Service Code	HCPCS 90746
Hospital Charge Code	105925438
Hospital Revenue Code	250
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$43.38
Rate for Payer: Aetna of AZ Commercial	$43.38
Rate for Payer: Bisbee Police All Plans	$12.53
Rate for Payer: Cash Price	$38.56
Rate for Payer: Self Pay Self Pay	$38.56

hepatitis B adult vaccine 20 mcg [CQCH]

Facility

OP

$48.20

Service Code	HCPCS 90746
Hospital Charge Code	105925438
Hospital Revenue Code	250
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$43.38
Rate for Payer: Aetna of AZ Commercial	$43.38
Rate for Payer: Aetna of AZ Medicare	$13.50
Rate for Payer: Allwell Medicare	$7.71
Rate for Payer: Amerigroup Medicare	$7.71
Rate for Payer: APIPA Medicare/Medicaid	$18.00
Rate for Payer: AZCH Complete Medicare	$7.71
Rate for Payer: Banner UC Health Medicare	$7.71
Rate for Payer: Bisbee Police All Plans	$12.53
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.78
Rate for Payer: Cash Price	$38.56
Rate for Payer: Cigna of AZ Commercial	$31.33
Rate for Payer: Copperpoint Commercial	$11.93
Rate for Payer: Health Net of AZ Commercial	$28.92
Rate for Payer: Health Net of AZ Medicare	$13.50
Rate for Payer: Humana of AZ Medicare	$7.71
Rate for Payer: Self Pay Self Pay	$38.56
Rate for Payer: TriWest Medicare	$7.71
Rate for Payer: UnitedHealth Group of AZ Commercial	$28.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.68

Hepatitis Be Ag, LC

Facility

IP

$226.00

Service Code	CPT 87350
Hospital Charge Code	4976988
Hospital Revenue Code	302
Min. Negotiated Rate	$58.76
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Bisbee Police All Plans	$58.76
Rate for Payer: Cash Price	$180.80
Rate for Payer: Self Pay Self Pay	$180.80

Hepatitis Be Ag, LC

Facility

OP

$226.00

Service Code	CPT 87350
Hospital Charge Code	4976988
Hospital Revenue Code	302
Min. Negotiated Rate	$36.16
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Aetna of AZ Medicare	$63.28
Rate for Payer: Allwell Medicare	$36.16
Rate for Payer: Amerigroup Medicare	$36.16
Rate for Payer: APIPA Medicare/Medicaid	$84.41
Rate for Payer: AZCH Complete Medicare	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Bisbee Police All Plans	$58.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.68
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$146.90
Rate for Payer: Copperpoint Commercial	$55.94
Rate for Payer: Health Net of AZ Commercial	$135.60
Rate for Payer: Health Net of AZ Medicare	$63.28
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Self Pay Self Pay	$180.80
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$131.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.68

Hepatitis B Surf Ab Quant LC

Facility

OP

$384.00

Service Code	CPT 86706
Hospital Charge Code	22201154
Hospital Revenue Code	306
Min. Negotiated Rate	$61.44
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Aetna of AZ Medicare	$107.52
Rate for Payer: Allwell Medicare	$61.44
Rate for Payer: Amerigroup Medicare	$61.44
Rate for Payer: APIPA Medicare/Medicaid	$143.42
Rate for Payer: AZCH Complete Medicare	$61.44
Rate for Payer: Banner UC Health Medicare	$61.44
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$261.12
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cigna of AZ Commercial	$249.60
Rate for Payer: Copperpoint Commercial	$95.04
Rate for Payer: Health Net of AZ Commercial	$230.40
Rate for Payer: Health Net of AZ Medicare	$107.52
Rate for Payer: Humana of AZ Medicare	$61.44
Rate for Payer: Self Pay Self Pay	$307.20
Rate for Payer: TriWest Medicare	$61.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$69.12

Hepatitis B Surf Ab Quant LC

Facility

IP

$384.00

Service Code	CPT 86706
Hospital Charge Code	22201154
Hospital Revenue Code	306
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Bisbee Police All Plans	$99.84
Rate for Payer: Cash Price	$307.20
Rate for Payer: Self Pay Self Pay	$307.20

.Hepatitis C Genotype LC

Facility

IP

$3,039.00

Service Code	CPT 87902
Hospital Charge Code	1285769
Hospital Revenue Code	306
Min. Negotiated Rate	$790.14
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Bisbee Police All Plans	$790.14
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Self Pay Self Pay	$2,431.20

.Hepatitis C Genotype LC

Facility

OP

$3,039.00

Service Code	CPT 87902
Hospital Charge Code	1285769
Hospital Revenue Code	306
Min. Negotiated Rate	$486.24
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Aetna of AZ Medicare	$850.92
Rate for Payer: Allwell Medicare	$486.24
Rate for Payer: Amerigroup Medicare	$486.24
Rate for Payer: APIPA Medicare/Medicaid	$1,135.07
Rate for Payer: AZCH Complete Medicare	$486.24
Rate for Payer: Banner UC Health Medicare	$486.24
Rate for Payer: Bisbee Police All Plans	$790.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,066.52
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Cigna of AZ Commercial	$1,975.35
Rate for Payer: Copperpoint Commercial	$752.15
Rate for Payer: Health Net of AZ Commercial	$1,823.40
Rate for Payer: Health Net of AZ Medicare	$850.92
Rate for Payer: Humana of AZ Medicare	$486.24
Rate for Payer: Self Pay Self Pay	$2,431.20
Rate for Payer: TriWest Medicare	$486.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,771.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$547.02

Hepatitis C Virus (HCV) RNA, Qualitative, NAA, LC

Facility

IP

$453.00

Service Code	CPT 87521
Hospital Charge Code	22084806
Hospital Revenue Code	306
Min. Negotiated Rate	$117.78
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna of AZ Commercial	$407.70
Rate for Payer: Bisbee Police All Plans	$117.78
Rate for Payer: Cash Price	$362.40
Rate for Payer: Self Pay Self Pay	$362.40

Hepatitis C Virus (HCV) RNA, Qualitative, NAA, LC

Facility

OP

$453.00

Service Code	CPT 87521
Hospital Charge Code	22084806
Hospital Revenue Code	306
Min. Negotiated Rate	$72.48
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna of AZ Commercial	$407.70
Rate for Payer: Aetna of AZ Medicare	$126.84
Rate for Payer: Allwell Medicare	$72.48
Rate for Payer: Amerigroup Medicare	$72.48
Rate for Payer: APIPA Medicare/Medicaid	$169.20
Rate for Payer: AZCH Complete Medicare	$72.48
Rate for Payer: Banner UC Health Medicare	$72.48
Rate for Payer: Bisbee Police All Plans	$117.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$308.04
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cigna of AZ Commercial	$294.45
Rate for Payer: Copperpoint Commercial	$112.12
Rate for Payer: Health Net of AZ Commercial	$271.80
Rate for Payer: Health Net of AZ Medicare	$126.84
Rate for Payer: Humana of AZ Medicare	$72.48
Rate for Payer: Self Pay Self Pay	$362.40
Rate for Payer: TriWest Medicare	$72.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$264.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$81.54

Hepatitis E IGG/IGM

Facility

IP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589663
Hospital Revenue Code	301
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

Hepatitis E IGG/IGM

Facility

OP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589663
Hospital Revenue Code	301
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$11.04
Rate for Payer: Amerigroup Medicare	$11.04
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

Hepatitis E IGG/IGM

Facility

OP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589636
Hospital Revenue Code	301
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Aetna of AZ Medicare	$19.32
Rate for Payer: Allwell Medicare	$11.04
Rate for Payer: Amerigroup Medicare	$11.04
Rate for Payer: APIPA Medicare/Medicaid	$25.77
Rate for Payer: AZCH Complete Medicare	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.92
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Copperpoint Commercial	$17.08
Rate for Payer: Health Net of AZ Commercial	$41.40
Rate for Payer: Health Net of AZ Medicare	$19.32
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Self Pay Self Pay	$55.20
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$40.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.42

Hepatitis E IGG/IGM

Facility

IP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589636
Hospital Revenue Code	301
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Bisbee Police All Plans	$17.94
Rate for Payer: Cash Price	$55.20
Rate for Payer: Self Pay Self Pay	$55.20

Hepatitis E Virus (HEV) IgG/M LC

Facility

OP

$257.00

Service Code	CPT 83883
Hospital Charge Code	22720193
Hospital Revenue Code	302
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Aetna of AZ Medicare	$71.96
Rate for Payer: Allwell Medicare	$41.12
Rate for Payer: Amerigroup Medicare	$41.12
Rate for Payer: APIPA Medicare/Medicaid	$95.99
Rate for Payer: AZCH Complete Medicare	$41.12
Rate for Payer: Banner UC Health Medicare	$41.12
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$174.76
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cigna of AZ Commercial	$167.05
Rate for Payer: Copperpoint Commercial	$63.61
Rate for Payer: Health Net of AZ Commercial	$154.20
Rate for Payer: Health Net of AZ Medicare	$71.96
Rate for Payer: Humana of AZ Medicare	$41.12
Rate for Payer: Self Pay Self Pay	$205.60
Rate for Payer: TriWest Medicare	$41.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$149.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.26

Hepatitis E Virus (HEV) IgG/M LC

Facility

IP

$257.00

Service Code	CPT 83883
Hospital Charge Code	22720193
Hospital Revenue Code	302
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$231.30
Rate for Payer: Aetna of AZ Commercial	$231.30
Rate for Payer: Bisbee Police All Plans	$66.82
Rate for Payer: Cash Price	$205.60
Rate for Payer: Self Pay Self Pay	$205.60

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