Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

EPIFIX 18MM DISK

Facility

$1,096.80

Service Code	CPT Q4186
Hospital Charge Code	27592022
Hospital Revenue Code	636
Min. Negotiated Rate	$175.49
Max. Negotiated Rate	$987.12
Rate for Payer: Aetna of AZ Commercial	$987.12
Rate for Payer: Aetna of AZ Medicare	$307.10
Rate for Payer: Allwell Medicare	$175.49
Rate for Payer: Amerigroup Medicare	$175.49
Rate for Payer: APIPA Medicare/Medicaid	$409.65
Rate for Payer: AZCH Complete Medicare	$175.49
Rate for Payer: Banner UC Health Medicare	$175.49
Rate for Payer: Bisbee Police All Plans	$285.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$745.82
Rate for Payer: Cash Price	$877.44
Rate for Payer: Cigna of AZ Commercial	$767.76
Rate for Payer: Copperpoint Commercial	$271.46
Rate for Payer: Health Net of AZ Commercial	$658.08
Rate for Payer: Health Net of AZ Medicare	$307.10
Rate for Payer: Humana of AZ Medicare	$175.49
Rate for Payer: Self Pay Self Pay	$877.44
Rate for Payer: TriWest Medicare	$175.49
Rate for Payer: UnitedHealth Group of AZ Commercial	$639.43
Rate for Payer: UnitedHealth Group of AZ Medicare	$197.42

EPIFIX 4 X 4.5CM

Facility

$1,200.00

Service Code	CPT Q4186
Hospital Charge Code	27592021
Hospital Revenue Code	636
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna of AZ Commercial	$1,080.00
Rate for Payer: Aetna of AZ Medicare	$336.00
Rate for Payer: Allwell Medicare	$192.00
Rate for Payer: Amerigroup Medicare	$192.00
Rate for Payer: APIPA Medicare/Medicaid	$448.20
Rate for Payer: AZCH Complete Medicare	$192.00
Rate for Payer: Banner UC Health Medicare	$192.00
Rate for Payer: Bisbee Police All Plans	$312.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$816.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Cigna of AZ Commercial	$840.00
Rate for Payer: Copperpoint Commercial	$297.00
Rate for Payer: Health Net of AZ Commercial	$720.00
Rate for Payer: Health Net of AZ Medicare	$336.00
Rate for Payer: Humana of AZ Medicare	$192.00
Rate for Payer: Self Pay Self Pay	$960.00
Rate for Payer: TriWest Medicare	$192.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$699.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$216.00

EPIFIX 4 X 4.5CM

Facility

$1,200.00

Service Code	CPT Q4186
Hospital Charge Code	27592021
Hospital Revenue Code	636
Min. Negotiated Rate	$312.00
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna of AZ Commercial	$1,080.00
Rate for Payer: Bisbee Police All Plans	$312.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Self Pay Self Pay	$960.00

EPINEPHrine 0.1 mg/mL Inj PFS 10 mL [CQCH]

Facility

$0.44

Service Code	HCPCS J0170
Hospital Charge Code	105920789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.35
Rate for Payer: Self Pay Self Pay	$0.35

EPINEPHrine 0.1 mg/mL Inj PFS 10 mL [CQCH]

Facility

$0.44

Service Code	HCPCS J0170
Hospital Charge Code	105920789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.40
Rate for Payer: Aetna of AZ Commercial	$0.40
Rate for Payer: Aetna of AZ Medicare	$0.12
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.16
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.30
Rate for Payer: Cash Price	$0.35
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.26
Rate for Payer: Health Net of AZ Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.35
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

EPINEPHrine 1 mg/mL Inj Sol 1 mL [CQCH]

Facility

$12.87

Service Code	HCPCS J0171
Hospital Charge Code	105920860
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$11.58
Rate for Payer: Aetna of AZ Commercial	$11.58
Rate for Payer: Bisbee Police All Plans	$3.35
Rate for Payer: Cash Price	$10.30
Rate for Payer: Self Pay Self Pay	$10.30

EPINEPHrine 1 mg/mL Inj Sol 1 mL [CQCH]

Facility

$12.87

Service Code	HCPCS J0171
Hospital Charge Code	105920860
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$11.58
Rate for Payer: Aetna of AZ Commercial	$11.58
Rate for Payer: Aetna of AZ Medicare	$3.60
Rate for Payer: Allwell Medicare	$2.06
Rate for Payer: Amerigroup Medicare	$2.06
Rate for Payer: APIPA Medicare/Medicaid	$4.81
Rate for Payer: AZCH Complete Medicare	$2.06
Rate for Payer: Banner UC Health Medicare	$2.06
Rate for Payer: Bisbee Police All Plans	$3.35
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.75
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cigna of AZ Commercial	$8.37
Rate for Payer: Copperpoint Commercial	$3.19
Rate for Payer: Health Net of AZ Commercial	$7.72
Rate for Payer: Health Net of AZ Medicare	$3.60
Rate for Payer: Humana of AZ Medicare	$2.06
Rate for Payer: Self Pay Self Pay	$10.30
Rate for Payer: TriWest Medicare	$2.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.32

EPINEPHrine 1 mg/mL Inj Sol 30 mL [CQCH]

Facility

$5.27

Service Code	HCPCS J0171
Hospital Charge Code	105920929
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$4.74
Rate for Payer: Aetna of AZ Commercial	$4.74
Rate for Payer: Aetna of AZ Medicare	$1.48
Rate for Payer: Allwell Medicare	$0.84
Rate for Payer: Amerigroup Medicare	$0.84
Rate for Payer: APIPA Medicare/Medicaid	$1.97
Rate for Payer: AZCH Complete Medicare	$0.84
Rate for Payer: Banner UC Health Medicare	$0.84
Rate for Payer: Bisbee Police All Plans	$1.37
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.58
Rate for Payer: Cash Price	$4.22
Rate for Payer: Cigna of AZ Commercial	$3.43
Rate for Payer: Copperpoint Commercial	$1.30
Rate for Payer: Health Net of AZ Commercial	$3.16
Rate for Payer: Health Net of AZ Medicare	$1.48
Rate for Payer: Humana of AZ Medicare	$0.84
Rate for Payer: Self Pay Self Pay	$4.22
Rate for Payer: TriWest Medicare	$0.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.95

EPINEPHrine 1 mg/mL Inj Sol 30 mL [CQCH]

Facility

$5.27

Service Code	HCPCS J0171
Hospital Charge Code	105920929
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$4.74
Rate for Payer: Aetna of AZ Commercial	$4.74
Rate for Payer: Bisbee Police All Plans	$1.37
Rate for Payer: Cash Price	$4.22
Rate for Payer: Self Pay Self Pay	$4.22

EPINEPHrine-lidocaine 1:100000-1% 10 ml Sol [CQCH]

Facility

$0.16

Service Code	NDC 63323048217
Hospital Charge Code	205015963
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.13
Rate for Payer: Self Pay Self Pay	$0.13

EPINEPHrine-lidocaine 1:100000-1% 10 ml Sol [CQCH]

Facility

$0.16

Service Code	NDC 63323048217
Hospital Charge Code	205015963
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of AZ Commercial	$0.14
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.06
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.11
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cigna of AZ Commercial	$0.10
Rate for Payer: Copperpoint Commercial	$0.04
Rate for Payer: Health Net of AZ Commercial	$0.10
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL [CQCH]

Facility

$0.09

Service Code	NDC 409317801
Hospital Charge Code	105920998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL [CQCH]

Facility

$0.09

Service Code	NDC 409317801
Hospital Charge Code	105920998
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

EPINEPHrine-lidocaine 1:100000-1% Sol 50 ml [CQCH]

Facility

$135.12

Service Code	NDC 63323048257
Hospital Charge Code	205010803
Hospital Revenue Code	250
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$121.61
Rate for Payer: Aetna of AZ Commercial	$121.61
Rate for Payer: Bisbee Police All Plans	$35.13
Rate for Payer: Cash Price	$108.10
Rate for Payer: Self Pay Self Pay	$108.10

EPINEPHrine-lidocaine 1:100000-1% Sol 50 ml [CQCH]

Facility

$135.12

Service Code	NDC 63323048257
Hospital Charge Code	205010803
Hospital Revenue Code	250
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$121.61
Rate for Payer: Aetna of AZ Commercial	$121.61
Rate for Payer: Aetna of AZ Medicare	$37.83
Rate for Payer: Allwell Medicare	$21.62
Rate for Payer: Amerigroup Medicare	$21.62
Rate for Payer: APIPA Medicare/Medicaid	$50.47
Rate for Payer: AZCH Complete Medicare	$21.62
Rate for Payer: Banner UC Health Medicare	$21.62
Rate for Payer: Bisbee Police All Plans	$35.13
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.88
Rate for Payer: Cash Price	$108.10
Rate for Payer: Cigna of AZ Commercial	$87.83
Rate for Payer: Copperpoint Commercial	$33.44
Rate for Payer: Health Net of AZ Commercial	$81.07
Rate for Payer: Health Net of AZ Medicare	$37.83
Rate for Payer: Humana of AZ Medicare	$21.62
Rate for Payer: Self Pay Self Pay	$108.10
Rate for Payer: TriWest Medicare	$21.62
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.32

EPINEPHrine-lidocaine 1:100000-2% Sol 20 mL [CQCH]

Facility

$0.05

Service Code	HCPCS J2001
Hospital Charge Code	108918758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.02
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.03
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.04
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

EPINEPHrine-lidocaine 1:100000-2% Sol 20 mL [CQCH]

Facility

$0.05

Service Code	HCPCS J2001
Hospital Charge Code	108918758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Aetna of AZ Commercial	$0.05
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.04
Rate for Payer: Self Pay Self Pay	$0.04

EPINEPHrine-lidocaine 1:200,000-0.5% Inj Sol 50 mL [CQCH]

Facility

$0.04

Service Code	NDC 63323048157
Hospital Charge Code	105921073
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.03
Rate for Payer: Self Pay Self Pay	$0.03

EPINEPHrine-lidocaine 1:200,000-0.5% Inj Sol 50 mL [CQCH]

Facility

$0.04

Service Code	NDC 63323048157
Hospital Charge Code	105921073
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of AZ Commercial	$0.04
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of AZ Commercial	$0.03
Rate for Payer: Copperpoint Commercial	$0.01
Rate for Payer: Health Net of AZ Commercial	$0.02
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.03
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.01

EPISTAXIS ANTERIOR/POSTERIOR

Facility

$159.00

Hospital Charge Code	22354927
Hospital Revenue Code	270
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

EPISTAXIS ANTERIOR/POSTERIOR

Facility

$159.00

Hospital Charge Code	22354927
Hospital Revenue Code	270
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: Allwell Medicare	$25.44
Rate for Payer: Amerigroup Medicare	$25.44
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicare	$25.44
Rate for Payer: Banner UC Health Medicare	$25.44
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$111.30
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$25.44
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$25.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

EPIX GRASPERS 5MM X 35CM

Facility

$225.00

Hospital Charge Code	28004103
Hospital Revenue Code	270
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Aetna of AZ Medicare	$63.00
Rate for Payer: Allwell Medicare	$36.00
Rate for Payer: Amerigroup Medicare	$36.00
Rate for Payer: APIPA Medicare/Medicaid	$84.04
Rate for Payer: AZCH Complete Medicare	$36.00
Rate for Payer: Banner UC Health Medicare	$36.00
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of AZ Commercial	$157.50
Rate for Payer: Copperpoint Commercial	$55.69
Rate for Payer: Health Net of AZ Commercial	$135.00
Rate for Payer: Health Net of AZ Medicare	$63.00
Rate for Payer: Humana of AZ Medicare	$36.00
Rate for Payer: Self Pay Self Pay	$180.00
Rate for Payer: TriWest Medicare	$36.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$131.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.50

EPIX GRASPERS 5MM X 35CM

Facility

$225.00

Hospital Charge Code	28004103
Hospital Revenue Code	270
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Cash Price	$180.00
Rate for Payer: Self Pay Self Pay	$180.00

epoetin alfa 40,000 units/mL preservative-free Sol[CQCH]

Facility

$559.94

Service Code	HCPCS J0885
Hospital Charge Code	239902997
Hospital Revenue Code	250
Min. Negotiated Rate	$145.58
Max. Negotiated Rate	$503.95
Rate for Payer: Aetna of AZ Commercial	$503.95
Rate for Payer: Bisbee Police All Plans	$145.58
Rate for Payer: Cash Price	$447.95
Rate for Payer: Self Pay Self Pay	$447.95

epoetin alfa 40,000 units/mL preservative-free Sol[CQCH]

Facility

$559.94

Service Code	HCPCS J0885
Hospital Charge Code	239902997
Hospital Revenue Code	250
Min. Negotiated Rate	$89.59
Max. Negotiated Rate	$503.95
Rate for Payer: Aetna of AZ Commercial	$503.95
Rate for Payer: Aetna of AZ Medicare	$156.78
Rate for Payer: Allwell Medicare	$89.59
Rate for Payer: Amerigroup Medicare	$89.59
Rate for Payer: APIPA Medicare/Medicaid	$209.14
Rate for Payer: AZCH Complete Medicare	$89.59
Rate for Payer: Banner UC Health Medicare	$89.59
Rate for Payer: Bisbee Police All Plans	$145.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$380.76
Rate for Payer: Cash Price	$447.95
Rate for Payer: Cigna of AZ Commercial	$363.96
Rate for Payer: Copperpoint Commercial	$138.59
Rate for Payer: Health Net of AZ Commercial	$335.96
Rate for Payer: Health Net of AZ Medicare	$156.78
Rate for Payer: Humana of AZ Medicare	$89.59
Rate for Payer: Self Pay Self Pay	$447.95
Rate for Payer: TriWest Medicare	$89.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$326.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$100.79

Know your out-of-pocket cost for care.

All Charges