Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

I-GEL 2

Facility

$60.00

Hospital Charge Code	22926454
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

I-GEL 2.5

Facility

$60.00

Hospital Charge Code	22926455
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

I-GEL 2.5

Facility

$60.00

Hospital Charge Code	22926455
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

I-GEL 3

Facility

$60.00

Hospital Charge Code	22926456
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

I-GEL 3

Facility

$60.00

Hospital Charge Code	22926456
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

I-GEL 4

Facility

$60.00

Hospital Charge Code	22926457
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.00
Rate for Payer: Amerigroup Medicare	$9.00
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.00
Rate for Payer: Banner UC Health Medicare	$9.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$42.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.00
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

I-GEL 4

Facility

$60.00

Hospital Charge Code	22926457
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

I-GEL 5

Facility

$57.00

Hospital Charge Code	22926458
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$8.55
Rate for Payer: Amerigroup Medicare	$8.55
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$8.55
Rate for Payer: Banner UC Health Medicare	$8.55
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$8.55
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$8.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

I-GEL 5

Facility

$57.00

Hospital Charge Code	22926458
Hospital Revenue Code	272
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

IGF-1 LC

Facility

$505.00

Service Code	CPT 84305
Hospital Charge Code	1906904
Hospital Revenue Code	301
Min. Negotiated Rate	$131.30
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna of AZ Commercial	$454.50
Rate for Payer: Bisbee Police All Plans	$131.30
Rate for Payer: Cash Price	$404.00
Rate for Payer: Self Pay Self Pay	$404.00

IGF-1 LC

Facility

$505.00

Service Code	CPT 84305
Hospital Charge Code	1906904
Hospital Revenue Code	301
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna of AZ Commercial	$454.50
Rate for Payer: Aetna of AZ Medicare	$141.40
Rate for Payer: AHCCCS Medicaid	$21.26
Rate for Payer: Allwell Medicaid	$21.26
Rate for Payer: Allwell Medicare	$75.75
Rate for Payer: Amerigroup Medicare	$75.75
Rate for Payer: APIPA Medicare/Medicaid	$188.62
Rate for Payer: AZCH Complete Medicaid	$21.26
Rate for Payer: AZCH Complete Medicare	$75.75
Rate for Payer: Banner UC Health Medicaid	$21.26
Rate for Payer: Banner UC Health Medicare	$75.75
Rate for Payer: Bisbee Police All Plans	$131.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$343.40
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cigna of AZ Commercial	$328.25
Rate for Payer: Copperpoint Commercial	$124.99
Rate for Payer: Health Net of AZ Commercial	$303.00
Rate for Payer: Health Net of AZ Medicare	$141.40
Rate for Payer: Humana of AZ Medicare	$75.75
Rate for Payer: Mercy Care Medicaid	$21.26
Rate for Payer: Self Pay Self Pay	$404.00
Rate for Payer: TriWest Medicare	$75.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$294.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$90.90

IgG Subclasses 1-4 LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	6781836
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IgG Subclasses 1-4 LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	6781836
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: AHCCCS Medicaid	$9.30
Rate for Payer: Allwell Medicaid	$9.30
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicaid	$9.30
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicaid	$9.30
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Mercy Care Medicaid	$9.30
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IgG, Subclasses(1-4) LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2029255
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: AHCCCS Medicaid	$9.30
Rate for Payer: Allwell Medicaid	$9.30
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicaid	$9.30
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicaid	$9.30
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Mercy Care Medicaid	$9.30
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IgG, Subclasses(1-4) LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2029255
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST A

Facility

$404.00

Service Code	CPT 74420
Hospital Charge Code	27797698
Hospital Revenue Code	360
Min. Negotiated Rate	$105.04
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Bisbee Police All Plans	$105.04
Rate for Payer: Cash Price	$323.20
Rate for Payer: Self Pay Self Pay	$323.20

IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST A

Facility

$404.00

Service Code	CPT 74420
Hospital Charge Code	27797698
Hospital Revenue Code	360
Min. Negotiated Rate	$60.60
Max. Negotiated Rate	$533.78
Rate for Payer: Aetna of AZ Commercial	$363.60
Rate for Payer: Aetna of AZ Medicare	$113.12
Rate for Payer: AHCCCS Medicaid	$533.78
Rate for Payer: Allwell Medicaid	$533.78
Rate for Payer: Allwell Medicare	$60.60
Rate for Payer: Amerigroup Medicare	$60.60
Rate for Payer: APIPA Medicare/Medicaid	$150.89
Rate for Payer: AZCH Complete Medicaid	$533.78
Rate for Payer: AZCH Complete Medicare	$60.60
Rate for Payer: Banner UC Health Medicaid	$533.78
Rate for Payer: Banner UC Health Medicare	$60.60
Rate for Payer: Bisbee Police All Plans	$105.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$274.72
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cigna of AZ Commercial	$202.00
Rate for Payer: Copperpoint Commercial	$99.99
Rate for Payer: Health Net of AZ Commercial	$242.40
Rate for Payer: Health Net of AZ Medicare	$113.12
Rate for Payer: Humana of AZ Medicare	$60.60
Rate for Payer: Mercy Care Medicaid	$533.78
Rate for Payer: Self Pay Self Pay	$323.20
Rate for Payer: TriWest Medicare	$60.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$235.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$72.72

imipenem-cilastatin 500 mg Inj [CQCH]

Facility

$8.35

Service Code	HCPCS J0743
Hospital Charge Code	120268247
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$15.64
Rate for Payer: Aetna of AZ Commercial	$7.52
Rate for Payer: Aetna of AZ Medicare	$2.34
Rate for Payer: AHCCCS Medicaid	$15.64
Rate for Payer: Allwell Medicaid	$15.64
Rate for Payer: Allwell Medicare	$1.25
Rate for Payer: Amerigroup Medicare	$1.25
Rate for Payer: APIPA Medicare/Medicaid	$3.12
Rate for Payer: AZCH Complete Medicaid	$15.64
Rate for Payer: AZCH Complete Medicare	$1.25
Rate for Payer: Banner UC Health Medicaid	$15.64
Rate for Payer: Banner UC Health Medicare	$1.25
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.68
Rate for Payer: Cash Price	$6.68
Rate for Payer: Cash Price	$6.68
Rate for Payer: Cigna of AZ Commercial	$5.43
Rate for Payer: Copperpoint Commercial	$2.07
Rate for Payer: Health Net of AZ Commercial	$5.01
Rate for Payer: Health Net of AZ Medicare	$2.34
Rate for Payer: Humana of AZ Medicare	$1.25
Rate for Payer: Mercy Care Medicaid	$15.64
Rate for Payer: Self Pay Self Pay	$6.68
Rate for Payer: TriWest Medicare	$1.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.50

imipenem-cilastatin 500 mg Inj [CQCH]

Facility

$8.35

Service Code	HCPCS J0743
Hospital Charge Code	120268247
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of AZ Commercial	$7.52
Rate for Payer: Bisbee Police All Plans	$2.17
Rate for Payer: Cash Price	$6.68
Rate for Payer: Self Pay Self Pay	$6.68

IMMNASSY FOR NONINFECT (CELIAC COMP)

Facility

$164.00

Service Code	CPT 83516
Hospital Charge Code	22481480
Hospital Revenue Code	301
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Cash Price	$131.20
Rate for Payer: Self Pay Self Pay	$131.20

IMMNASSY FOR NONINFECT (CELIAC COMP)

Facility

$164.00

Service Code	CPT 83516
Hospital Charge Code	22481480
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Aetna of AZ Medicare	$45.92
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$24.60
Rate for Payer: Amerigroup Medicare	$24.60
Rate for Payer: APIPA Medicare/Medicaid	$61.25
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$24.60
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$24.60
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$111.52
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$106.60
Rate for Payer: Copperpoint Commercial	$40.59
Rate for Payer: Health Net of AZ Commercial	$98.40
Rate for Payer: Health Net of AZ Medicare	$45.92
Rate for Payer: Humana of AZ Medicare	$24.60
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$131.20
Rate for Payer: TriWest Medicare	$24.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$95.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.52

IMMOBILIZER KNEE 20

Facility

$89.00

Hospital Charge Code	22354184
Hospital Revenue Code	270
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Cash Price	$71.20
Rate for Payer: Self Pay Self Pay	$71.20

IMMOBILIZER KNEE 20

Facility

$89.00

Hospital Charge Code	22354184
Hospital Revenue Code	270
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$80.10
Rate for Payer: Aetna of AZ Commercial	$80.10
Rate for Payer: Aetna of AZ Medicare	$24.92
Rate for Payer: Allwell Medicare	$13.35
Rate for Payer: Amerigroup Medicare	$13.35
Rate for Payer: APIPA Medicare/Medicaid	$33.24
Rate for Payer: AZCH Complete Medicare	$13.35
Rate for Payer: Banner UC Health Medicare	$13.35
Rate for Payer: Bisbee Police All Plans	$23.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$60.52
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cigna of AZ Commercial	$62.30
Rate for Payer: Copperpoint Commercial	$22.03
Rate for Payer: Health Net of AZ Commercial	$53.40
Rate for Payer: Health Net of AZ Medicare	$24.92
Rate for Payer: Humana of AZ Medicare	$13.35
Rate for Payer: Self Pay Self Pay	$71.20
Rate for Payer: TriWest Medicare	$13.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.02

IMMOBILIZER SHOULDER PED

Facility

$78.00

Hospital Charge Code	22354134
Hospital Revenue Code	270
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

IMMOBILIZER SHOULDER PED

Facility

$78.00

Hospital Charge Code	22354134
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$11.70
Rate for Payer: Amerigroup Medicare	$11.70
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$11.70
Rate for Payer: Banner UC Health Medicare	$11.70
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$11.70
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$11.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

Know your out-of-pocket cost for care.

All Charges