Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

DERMAGRAFT, PER SQUARE CENTIMETER

Facility

$170.00

Service Code	HCPCS Q4106
Hospital Charge Code	24049286
Hospital Revenue Code	636
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Arizona Complete Health Allwell	$27.20
Rate for Payer: Banner UC Health Medicare	$27.20
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$115.60
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$27.20
Rate for Payer: Care1st Health Plan Arizona Medicare	$27.20
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cigna of AZ Commercial	$119.00
Rate for Payer: Devoted Health Medicare	$30.60
Rate for Payer: Humana of AZ Medicare	$27.20
Rate for Payer: Southwest Service Administrators UFCW	$115.60
Rate for Payer: TriWest Medicare	$27.20
Rate for Payer: United Healthcare Commercial	$97.24
Rate for Payer: United Healthcare Medicare	$27.20
Rate for Payer: United Healthcare New Mexico Commercial	$32.30
Rate for Payer: Veterans Affairs TRICARE	$26.93

DESTRUCTION AND/OR REMOVAL OF GROWTH OF BLADDER AND URETHRA

Facility

$1,463.00

Service Code	CPT 52235
Hospital Charge Code	28169289
Hospital Revenue Code	360
Min. Negotiated Rate	$231.74
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$1,316.70
Rate for Payer: Arizona Complete Health Allwell	$234.08
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$994.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$234.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$234.08
Rate for Payer: Cash Price	$1,170.40
Rate for Payer: Cash Price	$1,170.40
Rate for Payer: Cash Price	$1,170.40
Rate for Payer: Cigna of AZ Commercial	$731.50
Rate for Payer: Devoted Health Medicare	$263.34
Rate for Payer: Humana of AZ Medicare	$234.08
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$994.84
Rate for Payer: TriWest Medicare	$234.08
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$234.08
Rate for Payer: Veterans Affairs TRICARE	$231.74

DESTRUCTION AND/OR REMOVAL OF GROWTH OF BLADDER AND URETHRA

Facility

$1,463.00

Service Code	CPT 52235
Hospital Charge Code	28169289
Hospital Revenue Code	360
Min. Negotiated Rate	$1,316.70
Max. Negotiated Rate	$1,316.70
Rate for Payer: Aetna of AZ Commercial	$1,316.70
Rate for Payer: Cash Price	$1,170.40

DESTRUCTION AND/OR REMOVAL OF LARGE GROWTH OF BLADDER USING

Facility

$1,986.00

Service Code	CPT 52240
Hospital Charge Code	28254329
Hospital Revenue Code	360
Min. Negotiated Rate	$1,787.40
Max. Negotiated Rate	$1,787.40
Rate for Payer: Aetna of AZ Commercial	$1,787.40
Rate for Payer: Cash Price	$1,588.80

DESTRUCTION AND/OR REMOVAL OF LARGE GROWTH OF BLADDER USING

Facility

$1,986.00

Service Code	CPT 52240
Hospital Charge Code	28254329
Hospital Revenue Code	360
Min. Negotiated Rate	$314.58
Max. Negotiated Rate	$8,296.15
Rate for Payer: Aetna of AZ Commercial	$1,787.40
Rate for Payer: Arizona Complete Health Allwell	$317.76
Rate for Payer: Banner UC Health Medicare	$1,977.90
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,350.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$317.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$317.76
Rate for Payer: Cash Price	$1,588.80
Rate for Payer: Cash Price	$1,588.80
Rate for Payer: Cash Price	$1,588.80
Rate for Payer: Cigna of AZ Commercial	$993.00
Rate for Payer: Devoted Health Medicare	$357.48
Rate for Payer: Humana of AZ Medicare	$317.76
Rate for Payer: NaphCare Correctional Healthcare	$1,977.90
Rate for Payer: Seven Corners Travel Insurance	$8,296.15
Rate for Payer: Southwest Service Administrators UFCW	$1,350.48
Rate for Payer: TriWest Medicare	$317.76
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$317.76
Rate for Payer: Veterans Affairs TRICARE	$314.58

Destruction Benign/Premalig Lesion Charge

Facility

$216.00

Service Code	CPT 17000
Hospital Charge Code	713765
Hospital Revenue Code	521
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Cash Price	$172.80

Destruction Benign/Premalig Lesion Charge

Facility

$216.00

Service Code	CPT 17000
Hospital Charge Code	713765
Hospital Revenue Code	521
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$310.43
Rate for Payer: Aetna of AZ Commercial	$194.40
Rate for Payer: Arizona Complete Health Allwell	$34.56
Rate for Payer: Banner UC Health Medicare	$34.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$146.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13.25
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$34.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$34.56
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna of AZ Commercial	$151.20
Rate for Payer: Devoted Health Medicare	$38.88
Rate for Payer: Humana of AZ Medicare	$34.56
Rate for Payer: Mercy Care Medicaid	$13.25
Rate for Payer: NaphCare Correctional Healthcare	$13.25
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$146.88
Rate for Payer: TriWest Medicare	$34.56
Rate for Payer: United Healthcare Commercial	$123.55
Rate for Payer: United Healthcare Medicare	$34.56
Rate for Payer: Veterans Affairs TRICARE	$34.21

Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 1

Facility

$266.00

Service Code	CPT 17110
Hospital Charge Code	753176
Hospital Revenue Code	521
Min. Negotiated Rate	$42.13
Max. Negotiated Rate	$310.43
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Arizona Complete Health Allwell	$42.56
Rate for Payer: Banner UC Health Medicare	$42.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$180.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$42.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$42.56
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cigna of AZ Commercial	$186.20
Rate for Payer: Devoted Health Medicare	$47.88
Rate for Payer: Humana of AZ Medicare	$42.56
Rate for Payer: Mercy Care Medicaid	$47.20
Rate for Payer: NaphCare Correctional Healthcare	$47.20
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$180.88
Rate for Payer: TriWest Medicare	$42.56
Rate for Payer: United Healthcare Commercial	$152.15
Rate for Payer: United Healthcare Medicare	$42.56
Rate for Payer: Veterans Affairs TRICARE	$42.13

Destruction (eg, laser/electro/cryo/chemosurgery/curettement), of warts; up to 1

Facility

$266.00

Service Code	CPT 17110
Hospital Charge Code	753176
Hospital Revenue Code	521
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$239.40
Rate for Payer: Aetna of AZ Commercial	$239.40
Rate for Payer: Cash Price	$212.80

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

$410.00

Service Code	CPT 17111
Hospital Charge Code	24049520
Hospital Revenue Code	360
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$369.00
Rate for Payer: Arizona Complete Health Allwell	$65.60
Rate for Payer: Banner UC Health Medicare	$65.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$278.80
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$52.22
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$65.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$65.60
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cigna of AZ Commercial	$205.00
Rate for Payer: Devoted Health Medicare	$73.80
Rate for Payer: Humana of AZ Medicare	$65.60
Rate for Payer: Mercy Care Medicaid	$52.22
Rate for Payer: NaphCare Correctional Healthcare	$52.22
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$278.80
Rate for Payer: TriWest Medicare	$65.60
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$65.60
Rate for Payer: Veterans Affairs TRICARE	$64.94

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

$410.00

Service Code	CPT 17111
Hospital Charge Code	24049520
Hospital Revenue Code	360
Min. Negotiated Rate	$369.00
Max. Negotiated Rate	$369.00
Rate for Payer: Aetna of AZ Commercial	$369.00
Rate for Payer: Cash Price	$328.00

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

$334.00

Service Code	CPT 17110
Hospital Charge Code	24049519
Hospital Revenue Code	360
Min. Negotiated Rate	$300.60
Max. Negotiated Rate	$300.60
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$267.20

DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY,

Facility

$317.00

Service Code	CPT 17110
Hospital Charge Code	24049519
Hospital Revenue Code	360
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$285.30
Rate for Payer: Aetna of AZ Commercial	$300.60
Rate for Payer: Arizona Complete Health Allwell	$53.44
Rate for Payer: Arizona Complete Health Allwell	$50.72
Rate for Payer: Banner UC Health Medicare	$53.44
Rate for Payer: Banner UC Health Medicare	$50.72
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$227.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$215.56
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$47.20
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$50.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$53.44
Rate for Payer: Care1st Health Plan Arizona Medicare	$50.72
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cigna of AZ Commercial	$167.00
Rate for Payer: Cigna of AZ Commercial	$158.50
Rate for Payer: Devoted Health Medicare	$60.12
Rate for Payer: Devoted Health Medicare	$57.06
Rate for Payer: Humana of AZ Medicare	$50.72
Rate for Payer: Humana of AZ Medicare	$53.44
Rate for Payer: Mercy Care Medicaid	$47.20
Rate for Payer: Mercy Care Medicaid	$47.20
Rate for Payer: NaphCare Correctional Healthcare	$47.20
Rate for Payer: NaphCare Correctional Healthcare	$47.20
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Seven Corners Travel Insurance	$310.43
Rate for Payer: Southwest Service Administrators UFCW	$227.12
Rate for Payer: Southwest Service Administrators UFCW	$215.56
Rate for Payer: TriWest Medicare	$50.72
Rate for Payer: TriWest Medicare	$53.44
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$50.72
Rate for Payer: United Healthcare Medicare	$53.44
Rate for Payer: Veterans Affairs TRICARE	$50.21
Rate for Payer: Veterans Affairs TRICARE	$52.91

DESTRUCTION OF GROWTH OF BLADDER AND URETHRA USING AN ENDOSC

Facility

$1,029.00

Service Code	CPT 52224
Hospital Charge Code	28256620
Hospital Revenue Code	360
Min. Negotiated Rate	$162.99
Max. Negotiated Rate	$5,454.10
Rate for Payer: Aetna of AZ Commercial	$926.10
Rate for Payer: Arizona Complete Health Allwell	$164.64
Rate for Payer: Banner UC Health Medicare	$1,171.31
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$699.72
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$550.55
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$164.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$164.64
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cigna of AZ Commercial	$514.50
Rate for Payer: Devoted Health Medicare	$185.22
Rate for Payer: Humana of AZ Medicare	$164.64
Rate for Payer: Mercy Care Medicaid	$550.55
Rate for Payer: NaphCare Correctional Healthcare	$1,171.31
Rate for Payer: Seven Corners Travel Insurance	$5,454.10
Rate for Payer: Southwest Service Administrators UFCW	$699.72
Rate for Payer: TriWest Medicare	$164.64
Rate for Payer: United Healthcare Commercial	$4,169.00
Rate for Payer: United Healthcare Medicare	$164.64
Rate for Payer: Veterans Affairs TRICARE	$162.99

DESTRUCTION OF GROWTH OF BLADDER AND URETHRA USING AN ENDOSC

Facility

$1,029.00

Service Code	CPT 52224
Hospital Charge Code	28256620
Hospital Revenue Code	360
Min. Negotiated Rate	$926.10
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna of AZ Commercial	$926.10
Rate for Payer: Cash Price	$823.20

DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION

Facility

$4,294.70

Service Code	CPT 46922
Hospital Revenue Code	750
Min. Negotiated Rate	$173.29
Max. Negotiated Rate	$4,294.70
Rate for Payer: Banner UC Health Medicare	$913.45
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$173.29
Rate for Payer: Mercy Care Medicaid	$173.29
Rate for Payer: NaphCare Correctional Healthcare	$913.45
Rate for Payer: Seven Corners Travel Insurance	$4,294.70
Rate for Payer: United Healthcare Commercial	$4,169.00

DETECTION OF ENDOMYSIAL ANTIBODY (EMA)

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28010047
Hospital Revenue Code	302
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

DETECTION OF ENDOMYSIAL ANTIBODY (EMA)

Facility

$60.00

Service Code	CPT 86231
Hospital Charge Code	28010047
Hospital Revenue Code	302
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Seven Corners Travel Insurance	$17.53
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY

Facility

$60.00

Service Code	CPT 86364
Hospital Charge Code	28008409
Hospital Revenue Code	302
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Arizona Complete Health Allwell	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$40.80
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.60
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Seven Corners Travel Insurance	$16.72
Rate for Payer: Southwest Service Administrators UFCW	$40.80
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: United Healthcare Commercial	$34.32
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: Veterans Affairs TRICARE	$9.50

DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY

Facility

$60.00

Service Code	CPT 86364
Hospital Charge Code	28008409
Hospital Revenue Code	302
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Cash Price	$48.00

DETECTION TEST BY NUCLEIC ACID FOR DIGESTIVE TRACT PATHOGEN,

Facility

$2,188.00

Service Code	CPT 87507
Hospital Charge Code	27658692
Hospital Revenue Code	301
Min. Negotiated Rate	$1,969.20
Max. Negotiated Rate	$1,969.20
Rate for Payer: Aetna of AZ Commercial	$1,969.20
Rate for Payer: Cash Price	$1,750.40

DETECTION TEST BY NUCLEIC ACID FOR DIGESTIVE TRACT PATHOGEN,

Facility

$2,188.00

Service Code	CPT 87507
Hospital Charge Code	27658692
Hospital Revenue Code	301
Min. Negotiated Rate	$346.58
Max. Negotiated Rate	$1,969.20
Rate for Payer: Aetna of AZ Commercial	$1,969.20
Rate for Payer: Arizona Complete Health Allwell	$350.08
Rate for Payer: Banner UC Health Medicare	$350.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,487.84
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$350.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$350.08
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cash Price	$1,750.40
Rate for Payer: Cigna of AZ Commercial	$1,422.20
Rate for Payer: Devoted Health Medicare	$393.84
Rate for Payer: Humana of AZ Medicare	$350.08
Rate for Payer: Seven Corners Travel Insurance	$604.33
Rate for Payer: Southwest Service Administrators UFCW	$1,487.84
Rate for Payer: TriWest Medicare	$350.08
Rate for Payer: United Healthcare Commercial	$1,251.54
Rate for Payer: United Healthcare Medicare	$350.08
Rate for Payer: Veterans Affairs TRICARE	$346.58

DEVELOPMENT TEST LIMIT

Facility

$36.00

Service Code	CPT 96110
Hospital Charge Code	2478910
Hospital Revenue Code	521
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Cash Price	$28.80

DEVELOPMENT TEST LIMIT

Facility

$36.00

Service Code	CPT 96110
Hospital Charge Code	2478910
Hospital Revenue Code	521
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Arizona Complete Health Allwell	$5.76
Rate for Payer: Banner UC Health Medicare	$5.76
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$24.48
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$5.76
Rate for Payer: Care1st Health Plan Arizona Medicare	$5.76
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of AZ Commercial	$25.20
Rate for Payer: Devoted Health Medicare	$6.48
Rate for Payer: Humana of AZ Medicare	$5.76
Rate for Payer: Southwest Service Administrators UFCW	$24.48
Rate for Payer: TriWest Medicare	$5.76
Rate for Payer: United Healthcare Commercial	$20.59
Rate for Payer: United Healthcare Medicare	$5.76
Rate for Payer: Veterans Affairs TRICARE	$5.70

dexamethasone 10 mg/mL Inj Sol [CQCH]

Facility

$4.07

Service Code	HCPCS J1100
Hospital Charge Code	105918016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$3.66
Rate for Payer: Aetna of AZ Commercial	$3.66
Rate for Payer: Arizona Complete Health Allwell	$0.65
Rate for Payer: Banner UC Health Medicare	$0.65
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.77
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.65
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.65
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of AZ Commercial	$2.65
Rate for Payer: Devoted Health Medicare	$0.73
Rate for Payer: Humana of AZ Medicare	$0.65
Rate for Payer: Southwest Service Administrators UFCW	$2.77
Rate for Payer: TriWest Medicare	$0.65
Rate for Payer: United Healthcare Commercial	$2.33
Rate for Payer: United Healthcare Medicare	$0.65
Rate for Payer: Veterans Affairs TRICARE	$0.64

Know your out-of-pocket cost for care.

All Charges