Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$1,708.20
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Cash Price	$1,518.40

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$229.21
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Arizona Complete Health Allwell	$303.68
Rate for Payer: Banner UC Health Medicare	$229.21
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,290.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$303.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$303.68
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Devoted Health Medicare	$341.64
Rate for Payer: Humana of AZ Medicare	$303.68
Rate for Payer: NaphCare Correctional Healthcare	$229.21
Rate for Payer: Seven Corners Travel Insurance	$1,328.71
Rate for Payer: Southwest Service Administrators UFCW	$1,290.64
Rate for Payer: TriWest Medicare	$303.68
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$303.68
Rate for Payer: United Healthcare New Mexico Commercial	$360.62
Rate for Payer: Veterans Affairs TRICARE	$300.64

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$2,671.00
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Arizona Complete Health Allwell	$303.68
Rate for Payer: Banner UC Health Medicare	$83.39
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,290.64
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$303.68
Rate for Payer: Care1st Health Plan Arizona Medicare	$303.68
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Devoted Health Medicare	$341.64
Rate for Payer: Humana of AZ Medicare	$303.68
Rate for Payer: NaphCare Correctional Healthcare	$83.39
Rate for Payer: Seven Corners Travel Insurance	$577.38
Rate for Payer: Southwest Service Administrators UFCW	$1,290.64
Rate for Payer: TriWest Medicare	$303.68
Rate for Payer: United Healthcare Commercial	$2,671.00
Rate for Payer: United Healthcare Medicare	$303.68
Rate for Payer: United Healthcare New Mexico Commercial	$360.62
Rate for Payer: Veterans Affairs TRICARE	$300.64

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$1,708.20
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Cash Price	$1,518.40

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$2,274.30
Max. Negotiated Rate	$2,274.30
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Cash Price	$2,021.60

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$400.28
Max. Negotiated Rate	$7,740.14
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Arizona Complete Health Allwell	$404.32
Rate for Payer: Banner UC Health Medicare	$404.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$1,718.36
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$1,136.66
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$404.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$404.32
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cigna of AZ Commercial	$1,768.90
Rate for Payer: Devoted Health Medicare	$454.86
Rate for Payer: Humana of AZ Medicare	$404.32
Rate for Payer: Mercy Care Medicaid	$1,136.66
Rate for Payer: NaphCare Correctional Healthcare	$1,136.66
Rate for Payer: Seven Corners Travel Insurance	$7,740.14
Rate for Payer: Southwest Service Administrators UFCW	$1,718.36
Rate for Payer: TriWest Medicare	$404.32
Rate for Payer: United Healthcare Commercial	$1,445.44
Rate for Payer: United Healthcare Medicare	$404.32
Rate for Payer: Veterans Affairs TRICARE	$400.28

ESTABLISHED PATIENT BRIEF COMMUNICATION TECHNOLOGY-BASED SERVICE WITH 5-10 MINUTE

Facility

$3.00

Service Code	CPT 98016
Hospital Charge Code	27945075
Hospital Revenue Code	521
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Cash Price	$2.40

ESTABLISHED PATIENT BRIEF COMMUNICATION TECHNOLOGY-BASED SERVICE WITH 5-10 MINUTE

Facility

$3.00

Service Code	CPT 98016
Hospital Charge Code	27945075
Hospital Revenue Code	521
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.70
Rate for Payer: Aetna of AZ Commercial	$2.70
Rate for Payer: Arizona Complete Health Allwell	$0.48
Rate for Payer: Banner UC Health Medicare	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2.04
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$0.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.48
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.48
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cigna of AZ Commercial	$2.10
Rate for Payer: Devoted Health Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.48
Rate for Payer: Mercy Care Medicaid	$0.96
Rate for Payer: NaphCare Correctional Healthcare	$0.96
Rate for Payer: Southwest Service Administrators UFCW	$2.04
Rate for Payer: TriWest Medicare	$0.48
Rate for Payer: United Healthcare Commercial	$1.72
Rate for Payer: United Healthcare Medicare	$0.48
Rate for Payer: Veterans Affairs TRICARE	$0.48

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH HIGH MEDICAL DECISION MAKING

Facility

$247.00

Service Code	CPT 98015
Hospital Charge Code	27941099
Hospital Revenue Code	521
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Cash Price	$197.60

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH HIGH MEDICAL DECISION MAKING

Facility

$247.00

Service Code	CPT 98015
Hospital Charge Code	27941099
Hospital Revenue Code	521
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Arizona Complete Health Allwell	$39.52
Rate for Payer: Banner UC Health Medicare	$39.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$167.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5.99
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.52
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cigna of AZ Commercial	$172.90
Rate for Payer: Devoted Health Medicare	$44.46
Rate for Payer: Humana of AZ Medicare	$39.52
Rate for Payer: Mercy Care Medicaid	$5.99
Rate for Payer: NaphCare Correctional Healthcare	$5.99
Rate for Payer: Southwest Service Administrators UFCW	$167.96
Rate for Payer: TriWest Medicare	$39.52
Rate for Payer: United Healthcare Commercial	$141.28
Rate for Payer: United Healthcare Medicare	$39.52
Rate for Payer: Veterans Affairs TRICARE	$39.12

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH LOW MEDICAL DECISION MAKING

Facility

$113.00

Service Code	CPT 98013
Hospital Charge Code	27945073
Hospital Revenue Code	521
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Arizona Complete Health Allwell	$18.08
Rate for Payer: Banner UC Health Medicare	$18.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$76.84
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$4.07
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$18.08
Rate for Payer: Care1st Health Plan Arizona Medicare	$18.08
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cigna of AZ Commercial	$79.10
Rate for Payer: Devoted Health Medicare	$20.34
Rate for Payer: Humana of AZ Medicare	$18.08
Rate for Payer: Mercy Care Medicaid	$4.07
Rate for Payer: NaphCare Correctional Healthcare	$4.07
Rate for Payer: Southwest Service Administrators UFCW	$76.84
Rate for Payer: TriWest Medicare	$18.08
Rate for Payer: United Healthcare Commercial	$64.64
Rate for Payer: United Healthcare Medicare	$18.08
Rate for Payer: Veterans Affairs TRICARE	$17.90

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH LOW MEDICAL DECISION MAKING

Facility

$113.00

Service Code	CPT 98013
Hospital Charge Code	27945073
Hospital Revenue Code	521
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Aetna of AZ Commercial	$101.70
Rate for Payer: Cash Price	$90.40

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH MODERATE MEDICAL DECISION MAKING

Facility

$168.00

Service Code	CPT 98014
Hospital Charge Code	27945074
Hospital Revenue Code	521
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Arizona Complete Health Allwell	$26.88
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$114.24
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$5.03
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$26.88
Rate for Payer: Care1st Health Plan Arizona Medicare	$26.88
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$117.60
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Mercy Care Medicaid	$5.03
Rate for Payer: NaphCare Correctional Healthcare	$5.03
Rate for Payer: Southwest Service Administrators UFCW	$114.24
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: United Healthcare Commercial	$96.10
Rate for Payer: United Healthcare Medicare	$26.88
Rate for Payer: Veterans Affairs TRICARE	$26.61

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH MODERATE MEDICAL DECISION MAKING

Facility

$168.00

Service Code	CPT 98014
Hospital Charge Code	27945074
Hospital Revenue Code	521
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Cash Price	$134.40

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING

Facility

$62.00

Service Code	CPT 98012
Hospital Charge Code	27945072
Hospital Revenue Code	521
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Arizona Complete Health Allwell	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$42.16
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$3.11
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$9.92
Rate for Payer: Care1st Health Plan Arizona Medicare	$9.92
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Devoted Health Medicare	$11.16
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Mercy Care Medicaid	$3.11
Rate for Payer: NaphCare Correctional Healthcare	$3.11
Rate for Payer: Southwest Service Administrators UFCW	$42.16
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: United Healthcare Commercial	$35.46
Rate for Payer: United Healthcare Medicare	$9.92
Rate for Payer: Veterans Affairs TRICARE	$9.82

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-ONLY VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING

Facility

$62.00

Service Code	CPT 98012
Hospital Charge Code	27945072
Hospital Revenue Code	521
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Cash Price	$49.60

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH HIGH MEDICAL DECISION MAKING

Facility

$247.00

Service Code	CPT 98007
Hospital Charge Code	27941097
Hospital Revenue Code	521
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Cash Price	$197.60

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH HIGH MEDICAL DECISION MAKING

Facility

$247.00

Service Code	CPT 98007
Hospital Charge Code	27941097
Hospital Revenue Code	521
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$222.30
Rate for Payer: Aetna of AZ Commercial	$222.30
Rate for Payer: Arizona Complete Health Allwell	$39.52
Rate for Payer: Banner UC Health Medicare	$39.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$167.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$26.35
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$39.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$39.52
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cigna of AZ Commercial	$172.90
Rate for Payer: Devoted Health Medicare	$44.46
Rate for Payer: Humana of AZ Medicare	$39.52
Rate for Payer: Mercy Care Medicaid	$26.35
Rate for Payer: NaphCare Correctional Healthcare	$26.35
Rate for Payer: Southwest Service Administrators UFCW	$167.96
Rate for Payer: TriWest Medicare	$39.52
Rate for Payer: United Healthcare Commercial	$141.28
Rate for Payer: United Healthcare Medicare	$39.52
Rate for Payer: Veterans Affairs TRICARE	$39.12

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH LOW MEDICAL DECISION MAKING

Facility

$124.00

Service Code	CPT 98005
Hospital Charge Code	27941095
Hospital Revenue Code	521
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Cash Price	$99.20

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH LOW MEDICAL DECISION MAKING

Facility

$124.00

Service Code	CPT 98005
Hospital Charge Code	27941095
Hospital Revenue Code	521
Min. Negotiated Rate	$17.97
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna of AZ Commercial	$111.60
Rate for Payer: Arizona Complete Health Allwell	$19.84
Rate for Payer: Banner UC Health Medicare	$19.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$84.32
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17.97
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$19.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$19.84
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cigna of AZ Commercial	$86.80
Rate for Payer: Devoted Health Medicare	$22.32
Rate for Payer: Humana of AZ Medicare	$19.84
Rate for Payer: Mercy Care Medicaid	$17.97
Rate for Payer: NaphCare Correctional Healthcare	$17.97
Rate for Payer: Southwest Service Administrators UFCW	$84.32
Rate for Payer: TriWest Medicare	$19.84
Rate for Payer: United Healthcare Commercial	$70.93
Rate for Payer: United Healthcare Medicare	$19.84
Rate for Payer: Veterans Affairs TRICARE	$19.64

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH MODERATE MEDICAL DECISION MAKING

Facility

$183.00

Service Code	CPT 98006
Hospital Charge Code	27941096
Hospital Revenue Code	521
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$164.70
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Cash Price	$146.40

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH MODERATE MEDICAL DECISION MAKING

Facility

$183.00

Service Code	CPT 98006
Hospital Charge Code	27941096
Hospital Revenue Code	521
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$164.70
Rate for Payer: Aetna of AZ Commercial	$164.70
Rate for Payer: Arizona Complete Health Allwell	$29.28
Rate for Payer: Banner UC Health Medicare	$29.28
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$124.44
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$22.28
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.28
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.28
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cigna of AZ Commercial	$128.10
Rate for Payer: Devoted Health Medicare	$32.94
Rate for Payer: Humana of AZ Medicare	$29.28
Rate for Payer: Mercy Care Medicaid	$22.28
Rate for Payer: NaphCare Correctional Healthcare	$22.28
Rate for Payer: Southwest Service Administrators UFCW	$124.44
Rate for Payer: TriWest Medicare	$29.28
Rate for Payer: United Healthcare Commercial	$104.68
Rate for Payer: United Healthcare Medicare	$29.28
Rate for Payer: Veterans Affairs TRICARE	$28.99

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING

Facility

$66.00

Service Code	CPT 98004
Hospital Charge Code	27941094
Hospital Revenue Code	521
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Arizona Complete Health Allwell	$10.56
Rate for Payer: Banner UC Health Medicare	$10.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$44.88
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$15.33
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$10.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$10.56
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cigna of AZ Commercial	$46.20
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Humana of AZ Medicare	$10.56
Rate for Payer: Mercy Care Medicaid	$15.33
Rate for Payer: NaphCare Correctional Healthcare	$15.33
Rate for Payer: Southwest Service Administrators UFCW	$44.88
Rate for Payer: TriWest Medicare	$10.56
Rate for Payer: United Healthcare Commercial	$37.75
Rate for Payer: United Healthcare Medicare	$10.56
Rate for Payer: Veterans Affairs TRICARE	$10.45

ESTABLISHED PATIENT SYNCHRONOUS AUDIO-VIDEO VISIT WITH STRAIGHTFORWARD MEDICAL DECISION MAKING

Facility

$66.00

Service Code	CPT 98004
Hospital Charge Code	27941094
Hospital Revenue Code	521
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna of AZ Commercial	$59.40
Rate for Payer: Cash Price	$52.80

Estradiol LC

Facility

$331.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$40.51
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Arizona Complete Health Allwell	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$225.08
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$52.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$52.96
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Devoted Health Medicare	$59.58
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Seven Corners Travel Insurance	$40.51
Rate for Payer: Southwest Service Administrators UFCW	$225.08
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: United Healthcare Commercial	$189.33
Rate for Payer: United Healthcare Medicare	$52.96
Rate for Payer: Veterans Affairs TRICARE	$52.43

Know your out-of-pocket cost for care.

All Charges