Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

hCG,Beta Subunit, Qnt, Serum LC

Facility

$207.00

Service Code	CPT 84702
Hospital Charge Code	1285573
Hospital Revenue Code	301
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of AZ Commercial	$186.30
Rate for Payer: Arizona Complete Health Allwell	$33.12
Rate for Payer: Banner UC Health Medicare	$33.12
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$140.76
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$33.12
Rate for Payer: Care1st Health Plan Arizona Medicare	$33.12
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cigna of AZ Commercial	$134.55
Rate for Payer: Devoted Health Medicare	$37.26
Rate for Payer: Humana of AZ Medicare	$33.12
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$140.76
Rate for Payer: TriWest Medicare	$33.12
Rate for Payer: United Healthcare Commercial	$118.40
Rate for Payer: United Healthcare Medicare	$33.12
Rate for Payer: Veterans Affairs TRICARE	$32.79

hCG Qual w/ Reflex to Beta hCG

Facility

$16.00

Service Code	CPT 84703
Hospital Charge Code	24319555
Hospital Revenue Code	300
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Cash Price	$12.80

hCG Qual w/ Reflex to Beta hCG

Facility

$16.00

Service Code	CPT 84703
Hospital Charge Code	24319555
Hospital Revenue Code	300
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Arizona Complete Health Allwell	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$10.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.56
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$10.40
Rate for Payer: Devoted Health Medicare	$2.88
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Seven Corners Travel Insurance	$10.90
Rate for Payer: Southwest Service Administrators UFCW	$10.88
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: United Healthcare Commercial	$9.15
Rate for Payer: United Healthcare Medicare	$2.56
Rate for Payer: Veterans Affairs TRICARE	$2.53

hCG Quantitative

Facility

$204.00

Service Code	CPT 84702
Hospital Charge Code	1019534
Hospital Revenue Code	301
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna of AZ Commercial	$183.60
Rate for Payer: Arizona Complete Health Allwell	$32.64
Rate for Payer: Banner UC Health Medicare	$32.64
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$138.72
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.64
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.64
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cigna of AZ Commercial	$132.60
Rate for Payer: Devoted Health Medicare	$36.72
Rate for Payer: Humana of AZ Medicare	$32.64
Rate for Payer: Seven Corners Travel Insurance	$21.82
Rate for Payer: Southwest Service Administrators UFCW	$138.72
Rate for Payer: TriWest Medicare	$32.64
Rate for Payer: United Healthcare Commercial	$116.69
Rate for Payer: United Healthcare Medicare	$32.64
Rate for Payer: Veterans Affairs TRICARE	$32.31

hCG Quantitative

Facility

$204.00

Service Code	CPT 84702
Hospital Charge Code	1019534
Hospital Revenue Code	301
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$183.60
Rate for Payer: Aetna of AZ Commercial	$183.60
Rate for Payer: Cash Price	$163.20

HCV Antibody LC

Facility

$377.00

Service Code	CPT 86803
Hospital Charge Code	23150799
Hospital Revenue Code	300
Min. Negotiated Rate	$20.69
Max. Negotiated Rate	$339.30
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Arizona Complete Health Allwell	$60.32
Rate for Payer: Banner UC Health Medicare	$60.32
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$256.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.32
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cigna of AZ Commercial	$245.05
Rate for Payer: Devoted Health Medicare	$67.86
Rate for Payer: Humana of AZ Medicare	$60.32
Rate for Payer: Seven Corners Travel Insurance	$20.69
Rate for Payer: Southwest Service Administrators UFCW	$256.36
Rate for Payer: TriWest Medicare	$60.32
Rate for Payer: United Healthcare Commercial	$215.64
Rate for Payer: United Healthcare Medicare	$60.32
Rate for Payer: Veterans Affairs TRICARE	$59.72

HCV Antibody LC

Facility

$377.00

Service Code	CPT 86803
Hospital Charge Code	23150799
Hospital Revenue Code	300
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$339.30
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Cash Price	$301.60

HCV Antibody LC

Facility

$506.00

Service Code	CPT 86803
Hospital Charge Code	1285627
Hospital Revenue Code	302
Min. Negotiated Rate	$20.69
Max. Negotiated Rate	$455.40
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Arizona Complete Health Allwell	$60.32
Rate for Payer: Arizona Complete Health Allwell	$80.96
Rate for Payer: Banner UC Health Medicare	$60.32
Rate for Payer: Banner UC Health Medicare	$80.96
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$344.08
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$256.36
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$60.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$80.96
Rate for Payer: Care1st Health Plan Arizona Medicare	$60.32
Rate for Payer: Care1st Health Plan Arizona Medicare	$80.96
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cigna of AZ Commercial	$328.90
Rate for Payer: Cigna of AZ Commercial	$245.05
Rate for Payer: Devoted Health Medicare	$91.08
Rate for Payer: Devoted Health Medicare	$67.86
Rate for Payer: Humana of AZ Medicare	$60.32
Rate for Payer: Humana of AZ Medicare	$80.96
Rate for Payer: Seven Corners Travel Insurance	$20.69
Rate for Payer: Seven Corners Travel Insurance	$20.69
Rate for Payer: Southwest Service Administrators UFCW	$256.36
Rate for Payer: Southwest Service Administrators UFCW	$344.08
Rate for Payer: TriWest Medicare	$60.32
Rate for Payer: TriWest Medicare	$80.96
Rate for Payer: United Healthcare Commercial	$289.43
Rate for Payer: United Healthcare Commercial	$215.64
Rate for Payer: United Healthcare Medicare	$60.32
Rate for Payer: United Healthcare Medicare	$80.96
Rate for Payer: Veterans Affairs TRICARE	$80.15
Rate for Payer: Veterans Affairs TRICARE	$59.72

HCV Antibody LC

Facility

$377.00

Service Code	CPT 86803
Hospital Charge Code	1285627
Hospital Revenue Code	302
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$339.30
Rate for Payer: Aetna of AZ Commercial	$339.30
Rate for Payer: Aetna of AZ Commercial	$455.40
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$404.80

HCV FibroSure LC

Facility

$150.00

Service Code	CPT 82977
Hospital Charge Code	22200129
Hospital Revenue Code	301
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$160.00

HCV FibroSure LC

Facility

$200.00

Service Code	CPT 82977
Hospital Charge Code	22200129
Hospital Revenue Code	301
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Aetna of AZ Commercial	$135.00
Rate for Payer: Arizona Complete Health Allwell	$24.00
Rate for Payer: Arizona Complete Health Allwell	$32.00
Rate for Payer: Banner UC Health Medicare	$24.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$136.00
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$102.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$24.00
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$32.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$24.00
Rate for Payer: Care1st Health Plan Arizona Medicare	$32.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Cigna of AZ Commercial	$97.50
Rate for Payer: Devoted Health Medicare	$36.00
Rate for Payer: Devoted Health Medicare	$27.00
Rate for Payer: Humana of AZ Medicare	$24.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Seven Corners Travel Insurance	$10.44
Rate for Payer: Seven Corners Travel Insurance	$10.44
Rate for Payer: Southwest Service Administrators UFCW	$102.00
Rate for Payer: Southwest Service Administrators UFCW	$136.00
Rate for Payer: TriWest Medicare	$24.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: United Healthcare Commercial	$114.40
Rate for Payer: United Healthcare Commercial	$85.80
Rate for Payer: United Healthcare Medicare	$24.00
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: Veterans Affairs TRICARE	$31.68
Rate for Payer: Veterans Affairs TRICARE	$23.76

HCV Genotyping Non Reflex LC

Facility

$3,199.00

Service Code	CPT 87902
Hospital Charge Code	2029260
Hospital Revenue Code	306
Min. Negotiated Rate	$2,879.10
Max. Negotiated Rate	$2,879.10
Rate for Payer: Aetna of AZ Commercial	$2,879.10
Rate for Payer: Cash Price	$2,559.20

HCV Genotyping Non Reflex LC

Facility

$3,199.00

Service Code	CPT 87902
Hospital Charge Code	2029260
Hospital Revenue Code	306
Min. Negotiated Rate	$373.30
Max. Negotiated Rate	$2,879.10
Rate for Payer: Aetna of AZ Commercial	$2,879.10
Rate for Payer: Arizona Complete Health Allwell	$511.84
Rate for Payer: Banner UC Health Medicare	$511.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$2,175.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$511.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$511.84
Rate for Payer: Cash Price	$2,559.20
Rate for Payer: Cash Price	$2,559.20
Rate for Payer: Cigna of AZ Commercial	$2,079.35
Rate for Payer: Devoted Health Medicare	$575.82
Rate for Payer: Humana of AZ Medicare	$511.84
Rate for Payer: Seven Corners Travel Insurance	$373.30
Rate for Payer: Southwest Service Administrators UFCW	$2,175.32
Rate for Payer: TriWest Medicare	$511.84
Rate for Payer: United Healthcare Commercial	$1,829.83
Rate for Payer: United Healthcare Medicare	$511.84
Rate for Payer: Veterans Affairs TRICARE	$506.72

.HCV RNA (International Units) LC

Facility

$430.00

Service Code	CPT 87521
Hospital Charge Code	1285759
Hospital Revenue Code	306
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna of AZ Commercial	$387.00
Rate for Payer: Arizona Complete Health Allwell	$68.80
Rate for Payer: Banner UC Health Medicare	$68.80
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$292.40
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$68.80
Rate for Payer: Care1st Health Plan Arizona Medicare	$68.80
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cash Price	$344.00
Rate for Payer: Cigna of AZ Commercial	$279.50
Rate for Payer: Devoted Health Medicare	$77.40
Rate for Payer: Humana of AZ Medicare	$68.80
Rate for Payer: Seven Corners Travel Insurance	$50.88
Rate for Payer: Southwest Service Administrators UFCW	$292.40
Rate for Payer: TriWest Medicare	$68.80
Rate for Payer: United Healthcare Commercial	$245.96
Rate for Payer: United Healthcare Medicare	$68.80
Rate for Payer: Veterans Affairs TRICARE	$68.11

.HCV RNA (International Units) LC

Facility

$430.00

Service Code	CPT 87521
Hospital Charge Code	1285759
Hospital Revenue Code	306
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna of AZ Commercial	$387.00
Rate for Payer: Cash Price	$344.00

.HCV RNA IU LC

Facility

$749.00

Service Code	CPT 87522
Hospital Charge Code	6782346
Hospital Revenue Code	301
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$674.10
Rate for Payer: Aetna of AZ Commercial	$674.10
Rate for Payer: Arizona Complete Health Allwell	$119.84
Rate for Payer: Banner UC Health Medicare	$119.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$509.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$119.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$119.84
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cigna of AZ Commercial	$486.85
Rate for Payer: Devoted Health Medicare	$134.82
Rate for Payer: Humana of AZ Medicare	$119.84
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$509.32
Rate for Payer: TriWest Medicare	$119.84
Rate for Payer: United Healthcare Commercial	$428.43
Rate for Payer: United Healthcare Medicare	$119.84
Rate for Payer: Veterans Affairs TRICARE	$118.64

.HCV RNA IU LC

Facility

$749.00

Service Code	CPT 87522
Hospital Charge Code	6782346
Hospital Revenue Code	301
Min. Negotiated Rate	$674.10
Max. Negotiated Rate	$674.10
Rate for Payer: Aetna of AZ Commercial	$674.10
Rate for Payer: Cash Price	$599.20

HCV RNA, PCR, Quant (Reflex to Genotyping LC

Facility

$651.00

Service Code	CPT 87522
Hospital Charge Code	6676609
Hospital Revenue Code	306
Min. Negotiated Rate	$585.90
Max. Negotiated Rate	$585.90
Rate for Payer: Aetna of AZ Commercial	$585.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$520.80

HCV RNA, PCR, Quant (Reflex to Genotyping LC

Facility

$651.00

Service Code	CPT 87522
Hospital Charge Code	6676609
Hospital Revenue Code	306
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$585.90
Rate for Payer: Aetna of AZ Commercial	$585.90
Rate for Payer: Aetna of AZ Commercial	$810.90
Rate for Payer: Arizona Complete Health Allwell	$104.16
Rate for Payer: Arizona Complete Health Allwell	$144.16
Rate for Payer: Banner UC Health Medicare	$104.16
Rate for Payer: Banner UC Health Medicare	$144.16
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$612.68
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$442.68
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$104.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$144.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$144.16
Rate for Payer: Care1st Health Plan Arizona Medicare	$104.16
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cigna of AZ Commercial	$423.15
Rate for Payer: Cigna of AZ Commercial	$585.65
Rate for Payer: Devoted Health Medicare	$117.18
Rate for Payer: Devoted Health Medicare	$162.18
Rate for Payer: Humana of AZ Medicare	$104.16
Rate for Payer: Humana of AZ Medicare	$144.16
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$442.68
Rate for Payer: Southwest Service Administrators UFCW	$612.68
Rate for Payer: TriWest Medicare	$104.16
Rate for Payer: TriWest Medicare	$144.16
Rate for Payer: United Healthcare Commercial	$372.37
Rate for Payer: United Healthcare Commercial	$515.37
Rate for Payer: United Healthcare Medicare	$104.16
Rate for Payer: United Healthcare Medicare	$144.16
Rate for Payer: Veterans Affairs TRICARE	$103.12
Rate for Payer: Veterans Affairs TRICARE	$142.72

HCV RT-PCR, Quant (Graph) LC

Facility

$749.00

Service Code	CPT 87522
Hospital Charge Code	2029096
Hospital Revenue Code	306
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$674.10
Rate for Payer: Aetna of AZ Commercial	$674.10
Rate for Payer: Arizona Complete Health Allwell	$119.84
Rate for Payer: Banner UC Health Medicare	$119.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$509.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$119.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$119.84
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cigna of AZ Commercial	$486.85
Rate for Payer: Devoted Health Medicare	$134.82
Rate for Payer: Humana of AZ Medicare	$119.84
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$509.32
Rate for Payer: TriWest Medicare	$119.84
Rate for Payer: United Healthcare Commercial	$428.43
Rate for Payer: United Healthcare Medicare	$119.84
Rate for Payer: Veterans Affairs TRICARE	$118.64

HCV RT-PCR, Quant (Graph) LC

Facility

$749.00

Service Code	CPT 87522
Hospital Charge Code	2029096
Hospital Revenue Code	306
Min. Negotiated Rate	$674.10
Max. Negotiated Rate	$674.10
Rate for Payer: Aetna of AZ Commercial	$674.10
Rate for Payer: Cash Price	$599.20

HCV RT-PCR, Quant (Non-Graph) LC

Facility

$747.00

Service Code	CPT 87522
Hospital Charge Code	1285758
Hospital Revenue Code	302
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$672.30
Rate for Payer: Aetna of AZ Commercial	$672.30
Rate for Payer: Arizona Complete Health Allwell	$119.52
Rate for Payer: Banner UC Health Medicare	$119.52
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$507.96
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$119.52
Rate for Payer: Care1st Health Plan Arizona Medicare	$119.52
Rate for Payer: Cash Price	$597.60
Rate for Payer: Cash Price	$597.60
Rate for Payer: Cigna of AZ Commercial	$485.55
Rate for Payer: Devoted Health Medicare	$134.46
Rate for Payer: Humana of AZ Medicare	$119.52
Rate for Payer: Seven Corners Travel Insurance	$62.12
Rate for Payer: Southwest Service Administrators UFCW	$507.96
Rate for Payer: TriWest Medicare	$119.52
Rate for Payer: United Healthcare Commercial	$427.28
Rate for Payer: United Healthcare Medicare	$119.52
Rate for Payer: Veterans Affairs TRICARE	$118.32

HCV RT-PCR, Quant (Non-Graph) LC

Facility

$747.00

Service Code	CPT 87522
Hospital Charge Code	1285758
Hospital Revenue Code	302
Min. Negotiated Rate	$672.30
Max. Negotiated Rate	$672.30
Rate for Payer: Aetna of AZ Commercial	$672.30
Rate for Payer: Cash Price	$597.60

HCV with Drug Resistance

Facility

$999.00

Service Code	CPT 87900
Hospital Charge Code	22907367
Hospital Revenue Code	306
Min. Negotiated Rate	$158.24
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Arizona Complete Health Allwell	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$679.32
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$159.84
Rate for Payer: Care1st Health Plan Arizona Medicare	$159.84
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Devoted Health Medicare	$179.82
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Seven Corners Travel Insurance	$189.01
Rate for Payer: Southwest Service Administrators UFCW	$679.32
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: United Healthcare Commercial	$571.43
Rate for Payer: United Healthcare Medicare	$159.84
Rate for Payer: Veterans Affairs TRICARE	$158.24

HCV with Drug Resistance

Facility

$999.00

Service Code	CPT 87900
Hospital Charge Code	22907367
Hospital Revenue Code	306
Min. Negotiated Rate	$899.10
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Cash Price	$799.20

Know your out-of-pocket cost for care.

All Charges