Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PURAPLY MZ 500MG

Facility

$9,280.00

Hospital Charge Code	27570616
Hospital Revenue Code	270
Min. Negotiated Rate	$2,412.80
Max. Negotiated Rate	$8,352.00
Rate for Payer: Aetna of AZ Commercial	$8,352.00
Rate for Payer: Bisbee Police All Plans	$2,412.80
Rate for Payer: Cash Price	$7,424.00
Rate for Payer: Self Pay Self Pay	$7,424.00

PURAPLY MZ 500MG

Facility

$9,280.00

Hospital Charge Code	27570616
Hospital Revenue Code	270
Min. Negotiated Rate	$1,392.00
Max. Negotiated Rate	$8,352.00
Rate for Payer: Aetna of AZ Commercial	$8,352.00
Rate for Payer: Aetna of AZ Medicare	$2,598.40
Rate for Payer: Allwell Medicare	$1,392.00
Rate for Payer: Amerigroup Medicare	$1,392.00
Rate for Payer: APIPA Medicare/Medicaid	$3,466.08
Rate for Payer: AZCH Complete Medicare	$1,392.00
Rate for Payer: Banner UC Health Medicare	$1,392.00
Rate for Payer: Bisbee Police All Plans	$2,412.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6,310.40
Rate for Payer: Cash Price	$7,424.00
Rate for Payer: Cigna of AZ Commercial	$6,496.00
Rate for Payer: Copperpoint Commercial	$2,296.80
Rate for Payer: Health Net of AZ Commercial	$5,568.00
Rate for Payer: Health Net of AZ Medicare	$2,598.40
Rate for Payer: Humana of AZ Medicare	$1,392.00
Rate for Payer: Self Pay Self Pay	$7,424.00
Rate for Payer: TriWest Medicare	$1,392.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,410.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,670.40

PuraPly XT

Facility

$11,794.00

Service Code	CPT Q4197
Hospital Charge Code	24363414
Hospital Revenue Code	636
Min. Negotiated Rate	$3,066.44
Max. Negotiated Rate	$10,614.60
Rate for Payer: Aetna of AZ Commercial	$10,614.60
Rate for Payer: Bisbee Police All Plans	$3,066.44
Rate for Payer: Cash Price	$9,435.20
Rate for Payer: Self Pay Self Pay	$9,435.20

PuraPly XT

Facility

$11,794.00

Service Code	CPT Q4197
Hospital Charge Code	24363414
Hospital Revenue Code	636
Min. Negotiated Rate	$1,769.10
Max. Negotiated Rate	$10,614.60
Rate for Payer: Aetna of AZ Commercial	$10,614.60
Rate for Payer: Aetna of AZ Medicare	$3,302.32
Rate for Payer: Allwell Medicare	$1,769.10
Rate for Payer: Amerigroup Medicare	$1,769.10
Rate for Payer: APIPA Medicare/Medicaid	$4,405.06
Rate for Payer: AZCH Complete Medicare	$1,769.10
Rate for Payer: Banner UC Health Medicare	$1,769.10
Rate for Payer: Bisbee Police All Plans	$3,066.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8,019.92
Rate for Payer: Cash Price	$9,435.20
Rate for Payer: Cigna of AZ Commercial	$8,255.80
Rate for Payer: Copperpoint Commercial	$2,919.02
Rate for Payer: Health Net of AZ Commercial	$7,076.40
Rate for Payer: Health Net of AZ Medicare	$3,302.32
Rate for Payer: Humana of AZ Medicare	$1,769.10
Rate for Payer: Self Pay Self Pay	$9,435.20
Rate for Payer: TriWest Medicare	$1,769.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$6,875.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$2,122.92

PUREWICK FEMALE EXTERNAL CATHETER

Facility

$71.00

Hospital Charge Code	27437084
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: Allwell Medicare	$10.65
Rate for Payer: Amerigroup Medicare	$10.65
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$10.65
Rate for Payer: Banner UC Health Medicare	$10.65
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$49.70
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$10.65
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$10.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

PUREWICK FEMALE EXTERNAL CATHETER

Facility

$71.00

Hospital Charge Code	27437084
Hospital Revenue Code	270
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

PURPLE INTRAOSSEOUS MODULE PEDS

Facility

$362.00

Hospital Charge Code	23175125
Hospital Revenue Code	272
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Cash Price	$289.60
Rate for Payer: Self Pay Self Pay	$289.60

PURPLE INTRAOSSEOUS MODULE PEDS

Facility

$362.00

Hospital Charge Code	23175125
Hospital Revenue Code	272
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Aetna of AZ Medicare	$101.36
Rate for Payer: Allwell Medicare	$54.30
Rate for Payer: Amerigroup Medicare	$54.30
Rate for Payer: APIPA Medicare/Medicaid	$135.21
Rate for Payer: AZCH Complete Medicare	$54.30
Rate for Payer: Banner UC Health Medicare	$54.30
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.16
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Copperpoint Commercial	$89.60
Rate for Payer: Health Net of AZ Commercial	$217.20
Rate for Payer: Health Net of AZ Medicare	$101.36
Rate for Payer: Humana of AZ Medicare	$54.30
Rate for Payer: Self Pay Self Pay	$289.60
Rate for Payer: TriWest Medicare	$54.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.16

PURPLE INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175713
Hospital Revenue Code	272
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

PURPLE INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175713
Hospital Revenue Code	272
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$45.30
Rate for Payer: Amerigroup Medicare	$45.30
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$45.30
Rate for Payer: Banner UC Health Medicare	$45.30
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$211.40
Rate for Payer: Copperpoint Commercial	$74.74
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$45.30
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$45.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

PURPLE IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175706
Hospital Revenue Code	272
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

PURPLE IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175706
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$43.50
Rate for Payer: Amerigroup Medicare	$43.50
Rate for Payer: APIPA Medicare/Medicaid	$108.32
Rate for Payer: AZCH Complete Medicare	$43.50
Rate for Payer: Banner UC Health Medicare	$43.50
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$203.00
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$43.50
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$43.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

PURPLE OXYGEN DELIVERY MODULE PEDS

Facility

$115.00

Hospital Charge Code	23175699
Hospital Revenue Code	272
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Aetna of AZ Medicare	$32.20
Rate for Payer: Allwell Medicare	$17.25
Rate for Payer: Amerigroup Medicare	$17.25
Rate for Payer: APIPA Medicare/Medicaid	$42.95
Rate for Payer: AZCH Complete Medicare	$17.25
Rate for Payer: Banner UC Health Medicare	$17.25
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$78.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cigna of AZ Commercial	$80.50
Rate for Payer: Copperpoint Commercial	$28.46
Rate for Payer: Health Net of AZ Commercial	$69.00
Rate for Payer: Health Net of AZ Medicare	$32.20
Rate for Payer: Humana of AZ Medicare	$17.25
Rate for Payer: Self Pay Self Pay	$92.00
Rate for Payer: TriWest Medicare	$17.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$67.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.70

PURPLE OXYGEN DELIVERY MODULE PEDS

Facility

$115.00

Hospital Charge Code	23175699
Hospital Revenue Code	272
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna of AZ Commercial	$103.50
Rate for Payer: Bisbee Police All Plans	$29.90
Rate for Payer: Cash Price	$92.00
Rate for Payer: Self Pay Self Pay	$92.00

Q3014 TELEHEALTH BURN SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282946
Hospital Revenue Code	780
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH BURN SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282946
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH CARDIO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282944
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH CARDIO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282944
Hospital Revenue Code	780
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH NEURO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282943
Hospital Revenue Code	780
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH NEURO SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282943
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282947
Hospital Revenue Code	780
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Q3014 TELEHEALTH PEDIATRICS SITE FACILITY FEE

Facility

$65.00

Service Code	CPT Q3014
Hospital Charge Code	22282947
Hospital Revenue Code	780
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$45.50
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Q3014 TELEHEALTH PULMON SITE FACILITY FEE

Facility

$62.00

Service Code	CPT Q3014
Hospital Charge Code	22282945
Hospital Revenue Code	780
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.30
Rate for Payer: Amerigroup Medicare	$9.30
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.30
Rate for Payer: Banner UC Health Medicare	$9.30
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.34
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.30
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

Q3014 TELEHEALTH PULMON SITE FACILITY FEE

Facility

$62.00

Service Code	CPT Q3014
Hospital Charge Code	22282945
Hospital Revenue Code	780
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

QuantiFERON Client Incubated LC

Facility

$770.00

Service Code	CPT 86480
Hospital Charge Code	6781827
Hospital Revenue Code	302
Min. Negotiated Rate	$61.98
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna of AZ Commercial	$693.00
Rate for Payer: Aetna of AZ Medicare	$215.60
Rate for Payer: AHCCCS Medicaid	$61.98
Rate for Payer: Allwell Medicaid	$61.98
Rate for Payer: Allwell Medicare	$115.50
Rate for Payer: Amerigroup Medicare	$115.50
Rate for Payer: APIPA Medicare/Medicaid	$287.60
Rate for Payer: AZCH Complete Medicaid	$61.98
Rate for Payer: AZCH Complete Medicare	$115.50
Rate for Payer: Banner UC Health Medicaid	$61.98
Rate for Payer: Banner UC Health Medicare	$115.50
Rate for Payer: Bisbee Police All Plans	$200.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$523.60
Rate for Payer: Cash Price	$616.00
Rate for Payer: Cash Price	$616.00
Rate for Payer: Cigna of AZ Commercial	$500.50
Rate for Payer: Copperpoint Commercial	$190.58
Rate for Payer: Health Net of AZ Commercial	$462.00
Rate for Payer: Health Net of AZ Medicare	$215.60
Rate for Payer: Humana of AZ Medicare	$115.50
Rate for Payer: Mercy Care Medicaid	$61.98
Rate for Payer: Self Pay Self Pay	$616.00
Rate for Payer: TriWest Medicare	$115.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$448.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.60

Know your out-of-pocket cost for care.

All Charges