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	APRDRG2793
Min. Negotiated Rate	$3,375.84
Max. Negotiated Rate	$3,375.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,375.84
Rate for Payer: Mercy Care Medicaid	$3,375.84
Rate for Payer: NaphCare Correctional Healthcare	$3,375.84

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$4,281.35

Service Code	APR-DRG 2792
Hospital Charge Code	APRDRG2791
Min. Negotiated Rate	$4,281.35
Max. Negotiated Rate	$4,281.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,281.35
Rate for Payer: Mercy Care Medicaid	$4,281.35
Rate for Payer: NaphCare Correctional Healthcare	$4,281.35

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: Blue Cross Blue Shield of Arizona Health Choice	$6,830.93
Rate for Payer: Mercy Care Medicaid	$6,830.93
Rate for Payer: NaphCare Correctional Healthcare	$6,830.93

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$3,375.84

Service Code	APR-DRG 2791
Hospital Charge Code	APRDRG2791
Min. Negotiated Rate	$3,375.84
Max. Negotiated Rate	$3,375.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,375.84
Rate for Payer: Mercy Care Medicaid	$3,375.84
Rate for Payer: NaphCare Correctional Healthcare	$3,375.84

Hepatic Coma And Other Major Acute Liver Disorders

Facility

IP

$16,093.62

Service Code	APR-DRG 2794
Hospital Charge Code	APRDRG2791
Min. Negotiated Rate	$16,093.62
Max. Negotiated Rate	$16,093.62
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$16,093.62
Rate for Payer: Mercy Care Medicaid	$16,093.62
Rate for Payer: NaphCare Correctional Healthcare	$16,093.62

Hepatic Function Panel Standard

Facility

IP

$287.00

Service Code	CPT 80076
Hospital Charge Code	22141045
Hospital Revenue Code	301
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Aetna of AZ Commercial	$178.20
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$158.40

Hepatic Function Panel Standard

Facility

OP

$198.00

Service Code	CPT 80076
Hospital Charge Code	22141045
Hospital Revenue Code	301
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna of AZ Commercial	$178.20
Rate for Payer: Aetna of AZ Commercial	$258.30
Rate for Payer: Arizona Complete Health Allwell	$45.92
Rate for Payer: Arizona Complete Health Allwell	$31.68
Rate for Payer: Banner UC Health Medicare	$45.92
Rate for Payer: Banner UC Health Medicare	$31.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$134.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$195.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$31.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$45.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$31.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$45.92
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cigna of AZ Commercial	$186.55
Rate for Payer: Cigna of AZ Commercial	$128.70
Rate for Payer: Devoted Health Medicare	$51.66
Rate for Payer: Devoted Health Medicare	$35.64
Rate for Payer: Humana of AZ Medicare	$31.68
Rate for Payer: Humana of AZ Medicare	$45.92
Rate for Payer: Seven Corners Travel Insurance	$11.85
Rate for Payer: Seven Corners Travel Insurance	$11.85
Rate for Payer: Southwest Service Administrators UFCW	$195.16
Rate for Payer: Southwest Service Administrators UFCW	$134.64
Rate for Payer: TriWest Medicare	$31.68
Rate for Payer: TriWest Medicare	$45.92
Rate for Payer: United Healthcare Commercial	$113.26
Rate for Payer: United Healthcare Commercial	$164.16
Rate for Payer: United Healthcare Medicare	$31.68
Rate for Payer: United Healthcare Medicare	$45.92
Rate for Payer: Veterans Affairs TRICARE	$45.46
Rate for Payer: Veterans Affairs TRICARE	$31.36

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	$10.03
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna of AZ Commercial	$56.99
Rate for Payer: Arizona Complete Health Allwell	$10.13
Rate for Payer: Banner UC Health Medicare	$10.13
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$43.06
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.13
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.13
Rate for Payer: Cash Price	$50.66
Rate for Payer: Cigna of AZ Commercial	$41.16
Rate for Payer: Devoted Health Medicare	$11.40
Rate for Payer: Humana of AZ Medicare	$10.13
Rate for Payer: Southwest Service Administrators UFCW	$43.06
Rate for Payer: TriWest Medicare	$10.13
Rate for Payer: United Healthcare Commercial	$36.22
Rate for Payer: United Healthcare Medicare	$10.13
Rate for Payer: Veterans Affairs TRICARE	$10.03

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	$56.99
Max. Negotiated Rate	$56.99
Rate for Payer: Aetna of AZ Commercial	$56.99
Rate for Payer: Cash Price	$50.66

Hepatitis A Adult Vaccine POC

Facility

OP

$271.00

Service Code	CPT 90632
Hospital Charge Code	667665
Hospital Revenue Code	521
Min. Negotiated Rate	$42.93
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Arizona Complete Health Allwell	$43.36
Rate for Payer: Banner UC Health Medicare	$43.36
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$184.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$43.36
Rate for Payer: Care1st Health Plan Arizona Medicare	$43.36
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cigna of AZ Commercial	$189.70
Rate for Payer: Devoted Health Medicare	$48.78
Rate for Payer: Humana of AZ Medicare	$43.36
Rate for Payer: Southwest Service Administrators UFCW	$184.28
Rate for Payer: TriWest Medicare	$43.36
Rate for Payer: United Healthcare Commercial	$155.01
Rate for Payer: United Healthcare Medicare	$43.36
Rate for Payer: Veterans Affairs TRICARE	$42.93

Hepatitis A Adult Vaccine POC

Facility

IP

$271.00

Service Code	CPT 90632
Hospital Charge Code	667665
Hospital Revenue Code	521
Min. Negotiated Rate	$243.90
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Cash Price	$216.80

Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge

Facility

OP

$141.00

Service Code	CPT 90633
Hospital Charge Code	667666
Hospital Revenue Code	636
Min. Negotiated Rate	$22.33
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Arizona Complete Health Allwell	$22.56
Rate for Payer: Banner UC Health Medicare	$22.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$95.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$22.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$22.56
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cigna of AZ Commercial	$98.70
Rate for Payer: Devoted Health Medicare	$25.38
Rate for Payer: Humana of AZ Medicare	$22.56
Rate for Payer: Southwest Service Administrators UFCW	$95.88
Rate for Payer: TriWest Medicare	$22.56
Rate for Payer: United Healthcare Commercial	$80.65
Rate for Payer: United Healthcare Medicare	$22.56
Rate for Payer: United Healthcare New Mexico Commercial	$26.79
Rate for Payer: Veterans Affairs TRICARE	$22.33

Hepatitis A Peds/Adol Vaccine 2 Dose Sched Charge

Facility

IP

$141.00

Service Code	CPT 90633
Hospital Charge Code	667666
Hospital Revenue Code	636
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna of AZ Commercial	$126.90
Rate for Payer: Cash Price	$112.80

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	$7.63
Max. Negotiated Rate	$43.38
Rate for Payer: Aetna of AZ Commercial	$43.38
Rate for Payer: Arizona Complete Health Allwell	$7.71
Rate for Payer: Banner UC Health Medicare	$7.71
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$32.78
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$7.71
Rate for Payer: Care1st Health Plan Arizona Medicare	$7.71
Rate for Payer: Cash Price	$38.56
Rate for Payer: Cigna of AZ Commercial	$31.33
Rate for Payer: Devoted Health Medicare	$8.68
Rate for Payer: Humana of AZ Medicare	$7.71
Rate for Payer: Southwest Service Administrators UFCW	$32.78
Rate for Payer: TriWest Medicare	$7.71
Rate for Payer: United Healthcare Commercial	$27.57
Rate for Payer: United Healthcare Medicare	$7.71
Rate for Payer: Veterans Affairs TRICARE	$7.63

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	$43.38
Max. Negotiated Rate	$43.38
Rate for Payer: Aetna of AZ Commercial	$43.38
Rate for Payer: Cash Price	$38.56

Hepatitis Be Ag, LC

Facility

IP

$226.00

Service Code	CPT 87350
Hospital Charge Code	4976988
Hospital Revenue Code	302
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Cash Price	$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	$16.72
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Arizona Complete Health Allwell	$36.16
Rate for Payer: Banner UC Health Medicare	$36.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$153.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$36.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$36.16
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cigna of AZ Commercial	$146.90
Rate for Payer: Devoted Health Medicare	$40.68
Rate for Payer: Humana of AZ Medicare	$36.16
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$153.68
Rate for Payer: TriWest Medicare	$36.16
Rate for Payer: United Healthcare Commercial	$129.27
Rate for Payer: United Healthcare Medicare	$36.16
Rate for Payer: Veterans Affairs TRICARE	$35.80

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	$15.57
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Arizona Complete Health Allwell	$61.44
Rate for Payer: Banner UC Health Medicare	$61.44
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$261.12
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$61.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$61.44
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cigna of AZ Commercial	$249.60
Rate for Payer: Devoted Health Medicare	$69.12
Rate for Payer: Humana of AZ Medicare	$61.44
Rate for Payer: Seven Corners Travel Insurance	$15.57
Rate for Payer: Southwest Service Administrators UFCW	$261.12
Rate for Payer: TriWest Medicare	$61.44
Rate for Payer: United Healthcare Commercial	$219.65
Rate for Payer: United Healthcare Medicare	$61.44
Rate for Payer: Veterans Affairs TRICARE	$60.83

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	$345.60
Max. Negotiated Rate	$345.60
Rate for Payer: Aetna of AZ Commercial	$345.60
Rate for Payer: Cash Price	$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	$2,735.10
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Cash Price	$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	$373.30
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Arizona Complete Health Allwell	$486.24
Rate for Payer: Banner UC Health Medicare	$486.24
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,066.52
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$486.24
Rate for Payer: Care1st Health Plan Arizona Medicare	$486.24
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Cigna of AZ Commercial	$1,975.35
Rate for Payer: Devoted Health Medicare	$547.02
Rate for Payer: Humana of AZ Medicare	$486.24
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$2,066.52
Rate for Payer: TriWest Medicare	$486.24
Rate for Payer: United Healthcare Commercial	$1,738.31
Rate for Payer: United Healthcare Medicare	$486.24
Rate for Payer: Veterans Affairs TRICARE	$481.38

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	$50.88
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna of AZ Commercial	$407.70
Rate for Payer: Arizona Complete Health Allwell	$72.48
Rate for Payer: Banner UC Health Medicare	$72.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$308.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$72.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$72.48
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cigna of AZ Commercial	$294.45
Rate for Payer: Devoted Health Medicare	$81.54
Rate for Payer: Humana of AZ Medicare	$72.48
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$308.04
Rate for Payer: TriWest Medicare	$72.48
Rate for Payer: United Healthcare Commercial	$259.12
Rate for Payer: United Healthcare Medicare	$72.48
Rate for Payer: Veterans Affairs TRICARE	$71.76

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	$407.70
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna of AZ Commercial	$407.70
Rate for Payer: Cash Price	$362.40

Hepatitis E IGG/IGM

Facility

OP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589663
Hospital Revenue Code	301
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Arizona Complete Health Allwell	$11.04
Rate for Payer: Banner UC Health Medicare	$11.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$46.92
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.04
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cigna of AZ Commercial	$44.85
Rate for Payer: Devoted Health Medicare	$12.42
Rate for Payer: Humana of AZ Medicare	$11.04
Rate for Payer: Seven Corners Travel Insurance	$19.72
Rate for Payer: Southwest Service Administrators UFCW	$46.92
Rate for Payer: TriWest Medicare	$11.04
Rate for Payer: United Healthcare Commercial	$39.47
Rate for Payer: United Healthcare Medicare	$11.04
Rate for Payer: Veterans Affairs TRICARE	$10.93

Hepatitis E IGG/IGM

Facility

IP

$69.00

Service Code	CPT 83883
Hospital Charge Code	22589636
Hospital Revenue Code	301
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Aetna of AZ Commercial	$62.10
Rate for Payer: Cash Price	$55.20

<<
<
251
252
253
254
255
256
257
258
259
260
>
>>