Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Gastrointestinal Panel Filmarray PCR

Facility

IP

$1,980.00

Service Code	CPT 87507
Hospital Charge Code	22961678
Hospital Revenue Code	301
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$1,782.00
Rate for Payer: Aetna of AZ Commercial	$1,782.00
Rate for Payer: Cash Price	$1,584.00

Gastrointestinal Panel Filmarray PCR

Facility

OP

$1,980.00

Service Code	CPT 87507
Hospital Charge Code	22961678
Hospital Revenue Code	301
Min. Negotiated Rate	$313.63
Max. Negotiated Rate	$1,782.00
Rate for Payer: Aetna of AZ Commercial	$1,782.00
Rate for Payer: Arizona Complete Health Allwell	$316.80
Rate for Payer: Banner UC Health Medicare	$316.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,346.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$316.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$316.80
Rate for Payer: Cash Price	$1,584.00
Rate for Payer: Cash Price	$1,584.00
Rate for Payer: Cigna of AZ Commercial	$1,287.00
Rate for Payer: Devoted Health Medicare	$356.40
Rate for Payer: Humana of AZ Medicare	$316.80
Rate for Payer: Seven Corners Travel Insurance	$604.33
Rate for Payer: Southwest Service Administrators UFCW	$1,346.40
Rate for Payer: TriWest Medicare	$316.80
Rate for Payer: United Healthcare Commercial	$1,132.56
Rate for Payer: United Healthcare Medicare	$316.80
Rate for Payer: Veterans Affairs TRICARE	$313.63

Gastrointestinal Vascular Insufficiency

Facility

IP

$7,315.60

Service Code	APR-DRG 2463
Hospital Charge Code	APRDRG2462
Min. Negotiated Rate	$7,315.60
Max. Negotiated Rate	$7,315.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,315.60
Rate for Payer: Mercy Care Medicaid	$7,315.60
Rate for Payer: NaphCare Correctional Healthcare	$7,315.60

Gastrointestinal Vascular Insufficiency

Facility

IP

$4,782.85

Service Code	APR-DRG 2462
Hospital Charge Code	APRDRG2464
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Gastrointestinal Vascular Insufficiency

Facility

IP

$12,765.48

Service Code	APR-DRG 2464
Hospital Charge Code	APRDRG2463
Min. Negotiated Rate	$12,765.48
Max. Negotiated Rate	$12,765.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,765.48
Rate for Payer: Mercy Care Medicaid	$12,765.48
Rate for Payer: NaphCare Correctional Healthcare	$12,765.48

Gastrointestinal Vascular Insufficiency

Facility

IP

$3,840.17

Service Code	APR-DRG 2461
Hospital Charge Code	APRDRG2464
Min. Negotiated Rate	$3,840.17
Max. Negotiated Rate	$3,840.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,840.17
Rate for Payer: Mercy Care Medicaid	$3,840.17
Rate for Payer: NaphCare Correctional Healthcare	$3,840.17

Gastrointestinal Vascular Insufficiency

Facility

IP

$12,765.48

Service Code	APR-DRG 2464
Hospital Charge Code	APRDRG2462
Min. Negotiated Rate	$12,765.48
Max. Negotiated Rate	$12,765.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,765.48
Rate for Payer: Mercy Care Medicaid	$12,765.48
Rate for Payer: NaphCare Correctional Healthcare	$12,765.48

Gastrointestinal Vascular Insufficiency

Facility

IP

$7,315.60

Service Code	APR-DRG 2463
Hospital Charge Code	APRDRG2464
Min. Negotiated Rate	$7,315.60
Max. Negotiated Rate	$7,315.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,315.60
Rate for Payer: Mercy Care Medicaid	$7,315.60
Rate for Payer: NaphCare Correctional Healthcare	$7,315.60

Gastrointestinal Vascular Insufficiency

Facility

IP

$4,782.85

Service Code	APR-DRG 2462
Hospital Charge Code	APRDRG2461
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Gastrointestinal Vascular Insufficiency

Facility

IP

$7,315.60

Service Code	APR-DRG 2463
Hospital Charge Code	APRDRG2463
Min. Negotiated Rate	$7,315.60
Max. Negotiated Rate	$7,315.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,315.60
Rate for Payer: Mercy Care Medicaid	$7,315.60
Rate for Payer: NaphCare Correctional Healthcare	$7,315.60

Gastrointestinal Vascular Insufficiency

Facility

IP

$4,782.85

Service Code	APR-DRG 2462
Hospital Charge Code	APRDRG2463
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Gastrointestinal Vascular Insufficiency

Facility

IP

$7,315.60

Service Code	APR-DRG 2463
Hospital Charge Code	APRDRG2461
Min. Negotiated Rate	$7,315.60
Max. Negotiated Rate	$7,315.60
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$7,315.60
Rate for Payer: Mercy Care Medicaid	$7,315.60
Rate for Payer: NaphCare Correctional Healthcare	$7,315.60

Gastrointestinal Vascular Insufficiency

Facility

IP

$3,840.17

Service Code	APR-DRG 2461
Hospital Charge Code	APRDRG2463
Min. Negotiated Rate	$3,840.17
Max. Negotiated Rate	$3,840.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,840.17
Rate for Payer: Mercy Care Medicaid	$3,840.17
Rate for Payer: NaphCare Correctional Healthcare	$3,840.17

Gastrointestinal Vascular Insufficiency

Facility

IP

$12,765.48

Service Code	APR-DRG 2464
Hospital Charge Code	APRDRG2461
Min. Negotiated Rate	$12,765.48
Max. Negotiated Rate	$12,765.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,765.48
Rate for Payer: Mercy Care Medicaid	$12,765.48
Rate for Payer: NaphCare Correctional Healthcare	$12,765.48

Gastrointestinal Vascular Insufficiency

Facility

IP

$12,765.48

Service Code	APR-DRG 2464
Hospital Charge Code	APRDRG2464
Min. Negotiated Rate	$12,765.48
Max. Negotiated Rate	$12,765.48
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$12,765.48
Rate for Payer: Mercy Care Medicaid	$12,765.48
Rate for Payer: NaphCare Correctional Healthcare	$12,765.48

Gastrointestinal Vascular Insufficiency

Facility

IP

$3,840.17

Service Code	APR-DRG 2461
Hospital Charge Code	APRDRG2461
Min. Negotiated Rate	$3,840.17
Max. Negotiated Rate	$3,840.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,840.17
Rate for Payer: Mercy Care Medicaid	$3,840.17
Rate for Payer: NaphCare Correctional Healthcare	$3,840.17

Gastrointestinal Vascular Insufficiency

Facility

IP

$4,782.85

Service Code	APR-DRG 2462
Hospital Charge Code	APRDRG2462
Min. Negotiated Rate	$4,782.85
Max. Negotiated Rate	$4,782.85
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,782.85
Rate for Payer: Mercy Care Medicaid	$4,782.85
Rate for Payer: NaphCare Correctional Healthcare	$4,782.85

Gastrointestinal Vascular Insufficiency

Facility

IP

$3,840.17

Service Code	APR-DRG 2461
Hospital Charge Code	APRDRG2462
Min. Negotiated Rate	$3,840.17
Max. Negotiated Rate	$3,840.17
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,840.17
Rate for Payer: Mercy Care Medicaid	$3,840.17
Rate for Payer: NaphCare Correctional Healthcare	$3,840.17

GC AMPLIFICTN

Facility

IP

$400.00

Service Code	CPT 87591
Hospital Charge Code	22481475
Hospital Revenue Code	306
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna of AZ Commercial	$360.00
Rate for Payer: Cash Price	$320.00

GC AMPLIFICTN

Facility

OP

$400.00

Service Code	CPT 87591
Hospital Charge Code	22481475
Hospital Revenue Code	306
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna of AZ Commercial	$360.00
Rate for Payer: Arizona Complete Health Allwell	$64.00
Rate for Payer: Banner UC Health Medicare	$64.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$272.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$64.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$64.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cigna of AZ Commercial	$260.00
Rate for Payer: Devoted Health Medicare	$72.00
Rate for Payer: Humana of AZ Medicare	$64.00
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$272.00
Rate for Payer: TriWest Medicare	$64.00
Rate for Payer: United Healthcare Commercial	$228.80
Rate for Payer: United Healthcare Medicare	$64.00
Rate for Payer: Veterans Affairs TRICARE	$63.36

GC ANTIBODY

Facility

OP

$353.00

Service Code	CPT 86609
Hospital Charge Code	23092679
Hospital Revenue Code	302
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna of AZ Commercial	$317.70
Rate for Payer: Arizona Complete Health Allwell	$56.48
Rate for Payer: Banner UC Health Medicare	$56.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$240.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$56.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$56.48
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cigna of AZ Commercial	$229.45
Rate for Payer: Devoted Health Medicare	$63.54
Rate for Payer: Humana of AZ Medicare	$56.48
Rate for Payer: Seven Corners Travel Insurance	$18.68
Rate for Payer: Southwest Service Administrators UFCW	$240.04
Rate for Payer: TriWest Medicare	$56.48
Rate for Payer: United Healthcare Commercial	$201.92
Rate for Payer: United Healthcare Medicare	$56.48
Rate for Payer: Veterans Affairs TRICARE	$55.92

GC ANTIBODY

Facility

IP

$353.00

Service Code	CPT 86609
Hospital Charge Code	23092679
Hospital Revenue Code	302
Min. Negotiated Rate	$317.70
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna of AZ Commercial	$317.70
Rate for Payer: Cash Price	$282.40

gemfibrozil 600 mg Tab [CQCH]

Facility

IP

$0.19

Service Code	NDC 60687022401
Hospital Charge Code	105923934
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Cash Price	$0.15

gemfibrozil 600 mg Tab [CQCH]

Facility

OP

$0.19

Service Code	NDC 60687022401
Hospital Charge Code	105923934
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.11
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

GENE ANALYSIS (BREAST CANCER 1 AND 2) FULL SEQUENCE AND DUPL

Facility

OP

$2,470.00

Service Code	CPT 81162
Hospital Charge Code	24077031
Hospital Revenue Code	301
Min. Negotiated Rate	$391.25
Max. Negotiated Rate	$2,646.08
Rate for Payer: Aetna of AZ Commercial	$2,223.00
Rate for Payer: Arizona Complete Health Allwell	$395.20
Rate for Payer: Banner UC Health Medicare	$395.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,679.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$395.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$395.20
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Cigna of AZ Commercial	$1,605.50
Rate for Payer: Devoted Health Medicare	$444.60
Rate for Payer: Humana of AZ Medicare	$395.20
Rate for Payer: Seven Corners Travel Insurance	$2,646.08
Rate for Payer: Southwest Service Administrators UFCW	$1,679.60
Rate for Payer: TriWest Medicare	$395.20
Rate for Payer: United Healthcare Commercial	$1,412.84
Rate for Payer: United Healthcare Medicare	$395.20
Rate for Payer: Veterans Affairs TRICARE	$391.25

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