Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Allogeneic Bone Marrow Transplant

Facility

IP

$40,658.05

Service Code	APR-DRG 0071
Hospital Charge Code	APRDRG0074
Min. Negotiated Rate	$40,658.05
Max. Negotiated Rate	$40,658.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,658.05
Rate for Payer: Mercy Care Medicaid	$40,658.05
Rate for Payer: NaphCare Correctional Healthcare	$40,658.05

Allogeneic Bone Marrow Transplant

Facility

IP

$70,931.88

Service Code	APR-DRG 0073
Hospital Charge Code	APRDRG0073
Min. Negotiated Rate	$70,931.88
Max. Negotiated Rate	$70,931.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$70,931.88
Rate for Payer: Mercy Care Medicaid	$70,931.88
Rate for Payer: NaphCare Correctional Healthcare	$70,931.88

Allogeneic Bone Marrow Transplant

Facility

IP

$137,807.57

Service Code	APR-DRG 0074
Hospital Charge Code	APRDRG0072
Min. Negotiated Rate	$137,807.57
Max. Negotiated Rate	$137,807.57
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$137,807.57
Rate for Payer: Mercy Care Medicaid	$137,807.57
Rate for Payer: NaphCare Correctional Healthcare	$137,807.57

Allogeneic Bone Marrow Transplant

Facility

IP

$40,658.05

Service Code	APR-DRG 0071
Hospital Charge Code	APRDRG0072
Min. Negotiated Rate	$40,658.05
Max. Negotiated Rate	$40,658.05
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$40,658.05
Rate for Payer: Mercy Care Medicaid	$40,658.05
Rate for Payer: NaphCare Correctional Healthcare	$40,658.05

Allogeneic Bone Marrow Transplant

Facility

IP

$58,909.18

Service Code	APR-DRG 0072
Hospital Charge Code	APRDRG0072
Min. Negotiated Rate	$58,909.18
Max. Negotiated Rate	$58,909.18
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$58,909.18
Rate for Payer: Mercy Care Medicaid	$58,909.18
Rate for Payer: NaphCare Correctional Healthcare	$58,909.18

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

IP

$155,321.03

Service Code	MSDRG 014
Min. Negotiated Rate	$155,321.03
Max. Negotiated Rate	$155,321.03
Rate for Payer: Seven Corners Travel Insurance	$155,321.03

allopurinol 100 mg Tab [CQCH]

Facility

OP

$0.26

Service Code	NDC 51079020520
Hospital Charge Code	105909905
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.18
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.18
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.15
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

allopurinol 100 mg Tab [CQCH]

Facility

IP

$0.26

Service Code	NDC 51079020520
Hospital Charge Code	105909905
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Cash Price	$0.21

ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST, PHENOTYPE

Facility

OP

$72.25

Service Code	CPT 82104
Hospital Charge Code	28008412
Hospital Revenue Code	302
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$65.03
Rate for Payer: Aetna of AZ Commercial	$65.03
Rate for Payer: Arizona Complete Health Allwell	$11.56
Rate for Payer: Banner UC Health Medicare	$11.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$49.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$11.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$11.56
Rate for Payer: Cash Price	$57.80
Rate for Payer: Cash Price	$57.80
Rate for Payer: Cigna of AZ Commercial	$46.96
Rate for Payer: Devoted Health Medicare	$13.01
Rate for Payer: Humana of AZ Medicare	$11.56
Rate for Payer: Seven Corners Travel Insurance	$20.97
Rate for Payer: Southwest Service Administrators UFCW	$49.13
Rate for Payer: TriWest Medicare	$11.56
Rate for Payer: United Healthcare Commercial	$41.33
Rate for Payer: United Healthcare Medicare	$11.56
Rate for Payer: Veterans Affairs TRICARE	$11.44

ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST, PHENOTYPE

Facility

IP

$72.25

Service Code	CPT 82104
Hospital Charge Code	28008412
Hospital Revenue Code	302
Min. Negotiated Rate	$65.03
Max. Negotiated Rate	$65.03
Rate for Payer: Aetna of AZ Commercial	$65.03
Rate for Payer: Cash Price	$57.80

Alpha-1-Antitrypsin, Serum LC

Facility

IP

$172.00

Service Code	CPT 82103
Hospital Charge Code	1905910
Hospital Revenue Code	301
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

Alpha-1-Antitrypsin, Serum LC

Facility

OP

$172.00

Service Code	CPT 82103
Hospital Charge Code	1905910
Hospital Revenue Code	301
Min. Negotiated Rate	$19.49
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	$19.49
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

ALPRAZolam 0.25 mg Oral DIS Tab [CQCH]

Facility

IP

$0.75

Service Code	NDC 49884011074
Hospital Charge Code	205191087
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Cash Price	$0.60

ALPRAZolam 0.25 mg Oral DIS Tab [CQCH]

Facility

OP

$0.75

Service Code	NDC 49884011074
Hospital Charge Code	205191087
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of AZ Commercial	$0.68
Rate for Payer: Arizona Complete Health Allwell	$0.12
Rate for Payer: Banner UC Health Medicare	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.51
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.12
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cigna of AZ Commercial	$0.49
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.12
Rate for Payer: Southwest Service Administrators UFCW	$0.51
Rate for Payer: TriWest Medicare	$0.12
Rate for Payer: United Healthcare Commercial	$0.43
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: Veterans Affairs TRICARE	$0.12

ALPRAZolam 1 mg Tab [CQCH]

Facility

IP

$0.06

Service Code	NDC 904586061
Hospital Charge Code	105910004
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Cash Price	$0.05

ALPRAZolam 1 mg Tab [CQCH]

Facility

OP

$0.06

Service Code	NDC 904586061
Hospital Charge Code	105910004
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Arizona Complete Health Allwell	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.01
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.01
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of AZ Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Southwest Service Administrators UFCW	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.03
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: Veterans Affairs TRICARE	$0.01

ALTAVIVA SYSTEM PACKS

Facility

IP

$106,705.00

Service Code	CPT 0816T
Hospital Charge Code	28172182
Hospital Revenue Code	278
Min. Negotiated Rate	$96,034.50
Max. Negotiated Rate	$96,034.50
Rate for Payer: Aetna of AZ Commercial	$96,034.50
Rate for Payer: Cash Price	$85,364.00

ALTAVIVA SYSTEM PACKS

Facility

OP

$106,705.00

Service Code	CPT 0816T
Hospital Charge Code	28172182
Hospital Revenue Code	278
Min. Negotiated Rate	$16,902.07
Max. Negotiated Rate	$96,034.50
Rate for Payer: Aetna of AZ Commercial	$96,034.50
Rate for Payer: Arizona Complete Health Allwell	$17,072.80
Rate for Payer: Banner UC Health Medicare	$17,072.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$72,559.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$17,072.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$17,072.80
Rate for Payer: Cash Price	$85,364.00
Rate for Payer: Cash Price	$85,364.00
Rate for Payer: Cigna of AZ Commercial	$53,352.50
Rate for Payer: Devoted Health Medicare	$19,206.90
Rate for Payer: Humana of AZ Medicare	$17,072.80
Rate for Payer: Seven Corners Travel Insurance	$30,017.20
Rate for Payer: Southwest Service Administrators UFCW	$72,559.40
Rate for Payer: TriWest Medicare	$17,072.80
Rate for Payer: United Healthcare Commercial	$61,035.26
Rate for Payer: United Healthcare Medicare	$17,072.80
Rate for Payer: Veterans Affairs TRICARE	$16,902.07

alteplase 100 mg IV Inj [CQCH]

Facility

IP

$9,069.76

Service Code	HCPCS J2997
Hospital Charge Code	105910209
Hospital Revenue Code	636
Min. Negotiated Rate	$8,162.78
Max. Negotiated Rate	$8,162.78
Rate for Payer: Aetna of AZ Commercial	$8,162.78
Rate for Payer: Cash Price	$7,255.81

alteplase 100 mg IV Inj [CQCH]

Facility

OP

$9,069.76

Service Code	HCPCS J2997
Hospital Charge Code	105910209
Hospital Revenue Code	636
Min. Negotiated Rate	$142.96
Max. Negotiated Rate	$8,162.78
Rate for Payer: Aetna of AZ Commercial	$8,162.78
Rate for Payer: Arizona Complete Health Allwell	$1,451.16
Rate for Payer: Banner UC Health Medicare	$1,451.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$6,167.44
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$1,451.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$1,451.16
Rate for Payer: Cash Price	$7,255.81
Rate for Payer: Cash Price	$7,255.81
Rate for Payer: Cigna of AZ Commercial	$6,348.83
Rate for Payer: Devoted Health Medicare	$1,632.56
Rate for Payer: Humana of AZ Medicare	$1,451.16
Rate for Payer: Seven Corners Travel Insurance	$142.96
Rate for Payer: Southwest Service Administrators UFCW	$6,167.44
Rate for Payer: TriWest Medicare	$1,451.16
Rate for Payer: United Healthcare Commercial	$5,187.90
Rate for Payer: United Healthcare Medicare	$1,451.16
Rate for Payer: United Healthcare New Mexico Commercial	$1,723.25
Rate for Payer: Veterans Affairs TRICARE	$1,436.65

alteplase 2 mg IV Inj [CQCH]

Facility

OP

$149.62

Service Code	HCPCS J2997
Hospital Charge Code	105910142
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$142.96
Rate for Payer: Aetna of AZ Commercial	$134.66
Rate for Payer: Arizona Complete Health Allwell	$23.94
Rate for Payer: Banner UC Health Medicare	$23.94
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$101.74
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$23.94
Rate for Payer: Care1st Health Plan Arizona Medicare	$23.94
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cash Price	$119.70
Rate for Payer: Cigna of AZ Commercial	$97.25
Rate for Payer: Devoted Health Medicare	$26.93
Rate for Payer: Humana of AZ Medicare	$23.94
Rate for Payer: Seven Corners Travel Insurance	$142.96
Rate for Payer: Southwest Service Administrators UFCW	$101.74
Rate for Payer: TriWest Medicare	$23.94
Rate for Payer: United Healthcare Commercial	$85.58
Rate for Payer: United Healthcare Medicare	$23.94
Rate for Payer: Veterans Affairs TRICARE	$23.70

alteplase 2 mg IV Inj [CQCH]

Facility

IP

$149.62

Service Code	HCPCS J2997
Hospital Charge Code	105910142
Hospital Revenue Code	250
Min. Negotiated Rate	$134.66
Max. Negotiated Rate	$134.66
Rate for Payer: Aetna of AZ Commercial	$134.66
Rate for Payer: Cash Price	$119.70

alteplase 50 mg REC[CQCH]

Facility

OP

$4,026.16

Service Code	HCPCS J2997
Hospital Charge Code	193296755
Hospital Revenue Code	636
Min. Negotiated Rate	$142.96
Max. Negotiated Rate	$3,623.54
Rate for Payer: Aetna of AZ Commercial	$3,623.54
Rate for Payer: Arizona Complete Health Allwell	$644.19
Rate for Payer: Banner UC Health Medicare	$644.19
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,737.79
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$644.19
Rate for Payer: Care1st Health Plan Arizona Medicare	$644.19
Rate for Payer: Cash Price	$3,220.93
Rate for Payer: Cash Price	$3,220.93
Rate for Payer: Cigna of AZ Commercial	$2,818.31
Rate for Payer: Devoted Health Medicare	$724.71
Rate for Payer: Humana of AZ Medicare	$644.19
Rate for Payer: Seven Corners Travel Insurance	$142.96
Rate for Payer: Southwest Service Administrators UFCW	$2,737.79
Rate for Payer: TriWest Medicare	$644.19
Rate for Payer: United Healthcare Commercial	$2,302.96
Rate for Payer: United Healthcare Medicare	$644.19
Rate for Payer: United Healthcare New Mexico Commercial	$764.97
Rate for Payer: Veterans Affairs TRICARE	$637.74

alteplase 50 mg REC[CQCH]

Facility

IP

$4,026.16

Service Code	HCPCS J2997
Hospital Charge Code	193296755
Hospital Revenue Code	636
Min. Negotiated Rate	$3,623.54
Max. Negotiated Rate	$3,623.54
Rate for Payer: Aetna of AZ Commercial	$3,623.54
Rate for Payer: Cash Price	$3,220.93

Alteration In Consciousness

Facility

IP

$4,026.04

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG0524
Min. Negotiated Rate	$4,026.04
Max. Negotiated Rate	$4,026.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4,026.04
Rate for Payer: Mercy Care Medicaid	$4,026.04
Rate for Payer: NaphCare Correctional Healthcare	$4,026.04

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