Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI

Facility

$723.00

Hospital Charge Code	22406138
Hospital Revenue Code	964
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Aetna of AZ Medicare	$202.44
Rate for Payer: Allwell Medicare	$115.68
Rate for Payer: Amerigroup Medicare	$115.68
Rate for Payer: APIPA Medicare/Medicaid	$270.04
Rate for Payer: AZCH Complete Medicare	$115.68
Rate for Payer: Banner UC Health Medicare	$115.68
Rate for Payer: Bisbee Police All Plans	$187.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$491.64
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cigna of AZ Commercial	$506.10
Rate for Payer: Copperpoint Commercial	$178.94
Rate for Payer: Health Net of AZ Commercial	$433.80
Rate for Payer: Health Net of AZ Medicare	$202.44
Rate for Payer: Humana of AZ Medicare	$115.68
Rate for Payer: Self Pay Self Pay	$578.40
Rate for Payer: TriWest Medicare	$115.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$421.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$130.14

00840 ANES INTRAPERITONEAL LOWER ABDOMEN BASE CHG AND 1ST MI

Facility

$723.00

Hospital Charge Code	22406138
Hospital Revenue Code	964
Min. Negotiated Rate	$187.98
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Bisbee Police All Plans	$187.98
Rate for Payer: Cash Price	$578.40
Rate for Payer: Self Pay Self Pay	$578.40

00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406142
Hospital Revenue Code	964
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$6.30
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00851 ANES TUBAL LIGATION TRASECTION ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406142
Hospital Revenue Code	964
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406141
Hospital Revenue Code	964
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Aetna of AZ Medicare	$202.44
Rate for Payer: Allwell Medicare	$115.68
Rate for Payer: Amerigroup Medicare	$115.68
Rate for Payer: APIPA Medicare/Medicaid	$270.04
Rate for Payer: AZCH Complete Medicare	$115.68
Rate for Payer: Banner UC Health Medicare	$115.68
Rate for Payer: Bisbee Police All Plans	$187.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$491.64
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cigna of AZ Commercial	$506.10
Rate for Payer: Copperpoint Commercial	$178.94
Rate for Payer: Health Net of AZ Commercial	$433.80
Rate for Payer: Health Net of AZ Medicare	$202.44
Rate for Payer: Humana of AZ Medicare	$115.68
Rate for Payer: Self Pay Self Pay	$578.40
Rate for Payer: TriWest Medicare	$115.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$421.51
Rate for Payer: UnitedHealth Group of AZ Medicare	$130.14

00851 ANES TUBAL LIGATION TRASECTION BASE CHARGE AND 1ST MIN

Facility

$723.00

Hospital Charge Code	22406141
Hospital Revenue Code	964
Min. Negotiated Rate	$187.98
Max. Negotiated Rate	$650.70
Rate for Payer: Aetna of AZ Commercial	$650.70
Rate for Payer: Bisbee Police All Plans	$187.98
Rate for Payer: Cash Price	$578.40
Rate for Payer: Self Pay Self Pay	$578.40

00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406210
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00860 ANES LOWER ABDOMEN ADDITIONAL MINUTES

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406210
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406213
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00860 ANES LOWER ABDOMEN ADDTNL 0:30 CHARGE

Facility

$9.00

Service Code	CPT 00860
Hospital Charge Code	22406213
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 00860
Hospital Charge Code	22406208
Hospital Revenue Code	964
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Aetna of AZ Medicare	$137.20
Rate for Payer: Allwell Medicare	$78.40
Rate for Payer: Amerigroup Medicare	$78.40
Rate for Payer: APIPA Medicare/Medicaid	$183.01
Rate for Payer: AZCH Complete Medicare	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$333.20
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Copperpoint Commercial	$121.28
Rate for Payer: Health Net of AZ Commercial	$294.00
Rate for Payer: Health Net of AZ Medicare	$137.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Self Pay Self Pay	$392.00
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$285.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.20

00860 ANES LOWER ABDOMEN BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Service Code	CPT 00860
Hospital Charge Code	22406208
Hospital Revenue Code	964
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Self Pay Self Pay	$392.00

00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406144
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00902 ANES ANORECTAL PROCEDURE ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406144
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406145
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00902 ANES ANORECTAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406145
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00902 ANES ANORECTAL PROCEDURE BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Hospital Charge Code	22406143
Hospital Revenue Code	964
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Aetna of AZ Medicare	$137.20
Rate for Payer: Allwell Medicare	$78.40
Rate for Payer: Amerigroup Medicare	$78.40
Rate for Payer: APIPA Medicare/Medicaid	$183.01
Rate for Payer: AZCH Complete Medicare	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$333.20
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Copperpoint Commercial	$121.28
Rate for Payer: Health Net of AZ Commercial	$294.00
Rate for Payer: Health Net of AZ Medicare	$137.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Self Pay Self Pay	$392.00
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$285.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.20

00902 ANES ANORECTAL PROCEDURE BASE CHARGE AND 1ST MINUTE

Facility

$490.00

Hospital Charge Code	22406143
Hospital Revenue Code	964
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Self Pay Self Pay	$392.00

00910 ANES TRANSURETHRAL PROCEDURE ADDITONAL MINS

Facility

$9.00

Hospital Charge Code	22406147
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00910 ANES TRANSURETHRAL PROCEDURE ADDITONAL MINS

Facility

$9.00

Hospital Charge Code	22406147
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00910 ANES TRANSURETHRAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406148
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

00910 ANES TRANSURETHRAL PROCEDURE ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406148
Hospital Revenue Code	370
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

00912 ANES TRANS RESECTION OF BLDR TUMERS ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406150
Hospital Revenue Code	370
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: Self Pay Self Pay	$7.20

00912 ANES TRANS RESECTION OF BLDR TUMERS ADDITIONAL MINUTES

Facility

$9.00

Hospital Charge Code	22406150
Hospital Revenue Code	370
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna of AZ Commercial	$8.10
Rate for Payer: Aetna of AZ Medicare	$2.52
Rate for Payer: Allwell Medicare	$1.44
Rate for Payer: Amerigroup Medicare	$1.44
Rate for Payer: APIPA Medicare/Medicaid	$3.36
Rate for Payer: AZCH Complete Medicare	$1.44
Rate for Payer: Banner UC Health Medicare	$1.44
Rate for Payer: Bisbee Police All Plans	$2.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of AZ Commercial	$5.85
Rate for Payer: Copperpoint Commercial	$2.23
Rate for Payer: Health Net of AZ Commercial	$5.40
Rate for Payer: Health Net of AZ Medicare	$2.52
Rate for Payer: Humana of AZ Medicare	$1.44
Rate for Payer: Self Pay Self Pay	$7.20
Rate for Payer: TriWest Medicare	$1.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.62

00912 ANES TRANS RESECTION OF BLDR TUMERS ADDTNL 0:30 CHARGE

Facility

$298.00

Hospital Charge Code	22406151
Hospital Revenue Code	370
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: Allwell Medicare	$47.68
Rate for Payer: Amerigroup Medicare	$47.68
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicare	$47.68
Rate for Payer: Banner UC Health Medicare	$47.68
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$193.70
Rate for Payer: Copperpoint Commercial	$73.75
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$47.68
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$47.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

Know your out-of-pocket cost for care.

All Charges