Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Topiramate (Topamax), Serum LC

Facility

OP

$303.00

Service Code	CPT 80201
Hospital Charge Code	2029223
Hospital Revenue Code	301
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$272.70
Rate for Payer: Aetna of AZ Commercial	$272.70
Rate for Payer: Arizona Complete Health Allwell	$48.48
Rate for Payer: Banner UC Health Medicare	$48.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$206.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$48.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$48.48
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cigna of AZ Commercial	$196.95
Rate for Payer: Devoted Health Medicare	$54.54
Rate for Payer: Humana of AZ Medicare	$48.48
Rate for Payer: Seven Corners Travel Insurance	$17.28
Rate for Payer: Southwest Service Administrators UFCW	$206.04
Rate for Payer: TriWest Medicare	$48.48
Rate for Payer: United Healthcare Commercial	$173.32
Rate for Payer: United Healthcare Medicare	$48.48
Rate for Payer: Veterans Affairs TRICARE	$48.00

Topiramate (Topamax), Serum LC

Facility

IP

$303.00

Service Code	CPT 80201
Hospital Charge Code	2029223
Hospital Revenue Code	301
Min. Negotiated Rate	$272.70
Max. Negotiated Rate	$272.70
Rate for Payer: Aetna of AZ Commercial	$272.70
Rate for Payer: Cash Price	$242.40

TOTAL PROTEIN 24HR URINE

Facility

IP

$100.00

Service Code	CPT 84156
Hospital Charge Code	22664814
Hospital Revenue Code	301
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Cash Price	$80.00

TOTAL PROTEIN 24HR URINE

Facility

OP

$100.00

Service Code	CPT 84156
Hospital Charge Code	22664814
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Arizona Complete Health Allwell	$16.00
Rate for Payer: Banner UC Health Medicare	$16.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$68.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$16.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$16.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna of AZ Commercial	$65.00
Rate for Payer: Devoted Health Medicare	$18.00
Rate for Payer: Humana of AZ Medicare	$16.00
Rate for Payer: Seven Corners Travel Insurance	$5.32
Rate for Payer: Southwest Service Administrators UFCW	$68.00
Rate for Payer: TriWest Medicare	$16.00
Rate for Payer: United Healthcare Commercial	$57.20
Rate for Payer: United Healthcare Medicare	$16.00
Rate for Payer: Veterans Affairs TRICARE	$15.84

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70
Rate for Payer: NaphCare Correctional Healthcare	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35
Rate for Payer: NaphCare Correctional Healthcare	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35
Rate for Payer: NaphCare Correctional Healthcare	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8163
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70
Rate for Payer: NaphCare Correctional Healthcare	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8162
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35
Rate for Payer: NaphCare Correctional Healthcare	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70
Rate for Payer: NaphCare Correctional Healthcare	$10,319.70

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$3,952.39

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG8161
Min. Negotiated Rate	$3,952.39
Max. Negotiated Rate	$3,952.39
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3,952.39
Rate for Payer: Mercy Care Medicaid	$3,952.39
Rate for Payer: NaphCare Correctional Healthcare	$3,952.39

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$5,035.35

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$5,035.35
Max. Negotiated Rate	$5,035.35
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5,035.35
Rate for Payer: Mercy Care Medicaid	$5,035.35
Rate for Payer: NaphCare Correctional Healthcare	$5,035.35

Toxic Effects Of Non-Medicinal Substances

Facility

IP

$10,319.70

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG8164
Min. Negotiated Rate	$10,319.70
Max. Negotiated Rate	$10,319.70
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$10,319.70
Rate for Payer: Mercy Care Medicaid	$10,319.70
Rate for Payer: NaphCare Correctional Healthcare	$10,319.70

Toxoplasma gondii Ab, IgG, Qn LC

Facility

OP

$172.00

Service Code	CPT 86777
Hospital Charge Code	7328613
Hospital Revenue Code	302
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Arizona Complete Health Allwell	$27.52
Rate for Payer: Banner UC Health Medicare	$27.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$116.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.52
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Devoted Health Medicare	$30.96
Rate for Payer: Humana of AZ Medicare	$27.52
Rate for Payer: Seven Corners Travel Insurance	$20.87
Rate for Payer: Southwest Service Administrators UFCW	$116.96
Rate for Payer: TriWest Medicare	$27.52
Rate for Payer: United Healthcare Commercial	$98.38
Rate for Payer: United Healthcare Medicare	$27.52
Rate for Payer: Veterans Affairs TRICARE	$27.24

Toxoplasma gondii Ab, IgG, Qn LC

Facility

IP

$172.00

Service Code	CPT 86777
Hospital Charge Code	7328613
Hospital Revenue Code	302
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Cash Price	$137.60

.Toxoplasma gondii Ab, IgM, Comment LC

Facility

OP

$181.00

Service Code	CPT 86777
Hospital Charge Code	22311169
Hospital Revenue Code	301
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.96
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Seven Corners Travel Insurance	$20.87
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: Veterans Affairs TRICARE	$28.67

.Toxoplasma gondii Ab, IgM, Comment LC

Facility

IP

$181.00

Service Code	CPT 86777
Hospital Charge Code	22311169
Hospital Revenue Code	301
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Cash Price	$144.80

Toxoplasma gondii IgM Ab LC

Facility

OP

$181.00

Service Code	CPT 86778
Hospital Charge Code	6782185
Hospital Revenue Code	302
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Arizona Complete Health Allwell	$28.96
Rate for Payer: Banner UC Health Medicare	$28.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$123.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$28.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$28.96
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Devoted Health Medicare	$32.58
Rate for Payer: Humana of AZ Medicare	$28.96
Rate for Payer: Seven Corners Travel Insurance	$20.89
Rate for Payer: Southwest Service Administrators UFCW	$123.08
Rate for Payer: TriWest Medicare	$28.96
Rate for Payer: United Healthcare Commercial	$103.53
Rate for Payer: United Healthcare Medicare	$28.96
Rate for Payer: Veterans Affairs TRICARE	$28.67

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