Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ravulizumab 100 mg/mL Sol[CQCH]

Facility

$2,134.67

Service Code	HCPCS J1303
Hospital Charge Code	212945258
Hospital Revenue Code	250
Min. Negotiated Rate	$555.01
Max. Negotiated Rate	$1,921.20
Rate for Payer: Aetna of AZ Commercial	$1,921.20
Rate for Payer: Bisbee Police All Plans	$555.01
Rate for Payer: Cash Price	$1,707.73
Rate for Payer: Self Pay Self Pay	$1,707.74

RBC CP2D AS3 500 LR

Facility

$755.00

Service Code	CPT P9016
Hospital Charge Code	857613
Hospital Revenue Code	390
Min. Negotiated Rate	$196.30
Max. Negotiated Rate	$679.50
Rate for Payer: Aetna of AZ Commercial	$679.50
Rate for Payer: Bisbee Police All Plans	$196.30
Rate for Payer: Cash Price	$604.00
Rate for Payer: Self Pay Self Pay	$604.00

RBC CP2D AS3 500 LR

Facility

$755.00

Service Code	CPT P9016
Hospital Charge Code	857613
Hospital Revenue Code	390
Min. Negotiated Rate	$120.80
Max. Negotiated Rate	$679.50
Rate for Payer: Aetna of AZ Commercial	$679.50
Rate for Payer: Aetna of AZ Medicare	$211.40
Rate for Payer: Allwell Medicare	$120.80
Rate for Payer: Amerigroup Medicare	$120.80
Rate for Payer: APIPA Medicare/Medicaid	$281.99
Rate for Payer: AZCH Complete Medicare	$120.80
Rate for Payer: Banner UC Health Medicare	$120.80
Rate for Payer: Bisbee Police All Plans	$196.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$513.40
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cigna of AZ Commercial	$490.75
Rate for Payer: Copperpoint Commercial	$186.86
Rate for Payer: Health Net of AZ Commercial	$453.00
Rate for Payer: Health Net of AZ Medicare	$211.40
Rate for Payer: Humana of AZ Medicare	$120.80
Rate for Payer: Self Pay Self Pay	$604.00
Rate for Payer: TriWest Medicare	$120.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$440.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$135.90

RBC CP2D AS3 500 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857635
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

RBC CP2D AS3 500 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857635
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

RBC CPD 500 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857651
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

RBC CPD 500 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857651
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

RBC CPD 500 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857652
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

RBC CPD 500 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857652
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

RBC CPD AS1 500 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857663
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

RBC CPD AS1 500 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	857663
Hospital Revenue Code	390
Min. Negotiated Rate	$127.84
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: Allwell Medicare	$127.84
Rate for Payer: Amerigroup Medicare	$127.84
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicare	$127.84
Rate for Payer: Banner UC Health Medicare	$127.84
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$127.84
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$127.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

RBC CPD AS1 500 LR Irr

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	857630
Hospital Revenue Code	390
Min. Negotiated Rate	$197.86
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Cash Price	$608.80
Rate for Payer: Self Pay Self Pay	$608.80

RBC CPD AS1 500 LR Irr

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	857630
Hospital Revenue Code	390
Min. Negotiated Rate	$121.76
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Aetna of AZ Medicare	$213.08
Rate for Payer: Allwell Medicare	$121.76
Rate for Payer: Amerigroup Medicare	$121.76
Rate for Payer: APIPA Medicare/Medicaid	$284.23
Rate for Payer: AZCH Complete Medicare	$121.76
Rate for Payer: Banner UC Health Medicare	$121.76
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$517.48
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$494.65
Rate for Payer: Copperpoint Commercial	$188.35
Rate for Payer: Health Net of AZ Commercial	$456.60
Rate for Payer: Health Net of AZ Medicare	$213.08
Rate for Payer: Humana of AZ Medicare	$121.76
Rate for Payer: Self Pay Self Pay	$608.80
Rate for Payer: TriWest Medicare	$121.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$443.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.98

RECHARGER BELT

Facility

$263.00

Hospital Charge Code	27400598
Hospital Revenue Code	270
Min. Negotiated Rate	$68.38
Max. Negotiated Rate	$236.70
Rate for Payer: Aetna of AZ Commercial	$236.70
Rate for Payer: Bisbee Police All Plans	$68.38
Rate for Payer: Cash Price	$210.40
Rate for Payer: Self Pay Self Pay	$210.40

RECHARGER BELT

Facility

$263.00

Hospital Charge Code	27400598
Hospital Revenue Code	270
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$236.70
Rate for Payer: Aetna of AZ Commercial	$236.70
Rate for Payer: Aetna of AZ Medicare	$73.64
Rate for Payer: Allwell Medicare	$42.08
Rate for Payer: Amerigroup Medicare	$42.08
Rate for Payer: APIPA Medicare/Medicaid	$98.23
Rate for Payer: AZCH Complete Medicare	$42.08
Rate for Payer: Banner UC Health Medicare	$42.08
Rate for Payer: Bisbee Police All Plans	$68.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$178.84
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cigna of AZ Commercial	$184.10
Rate for Payer: Copperpoint Commercial	$65.09
Rate for Payer: Health Net of AZ Commercial	$157.80
Rate for Payer: Health Net of AZ Medicare	$73.64
Rate for Payer: Humana of AZ Medicare	$42.08
Rate for Payer: Self Pay Self Pay	$210.40
Rate for Payer: TriWest Medicare	$42.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$153.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$47.34

RECHARGER KIT

Facility

$7,088.00

Hospital Charge Code	27400597
Hospital Revenue Code	270
Min. Negotiated Rate	$1,134.08
Max. Negotiated Rate	$6,379.20
Rate for Payer: Aetna of AZ Commercial	$6,379.20
Rate for Payer: Aetna of AZ Medicare	$1,984.64
Rate for Payer: Allwell Medicare	$1,134.08
Rate for Payer: Amerigroup Medicare	$1,134.08
Rate for Payer: APIPA Medicare/Medicaid	$2,647.37
Rate for Payer: AZCH Complete Medicare	$1,134.08
Rate for Payer: Banner UC Health Medicare	$1,134.08
Rate for Payer: Bisbee Police All Plans	$1,842.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$4,819.84
Rate for Payer: Cash Price	$5,670.40
Rate for Payer: Cigna of AZ Commercial	$4,961.60
Rate for Payer: Copperpoint Commercial	$1,754.28
Rate for Payer: Health Net of AZ Commercial	$4,252.80
Rate for Payer: Health Net of AZ Medicare	$1,984.64
Rate for Payer: Humana of AZ Medicare	$1,134.08
Rate for Payer: Self Pay Self Pay	$5,670.40
Rate for Payer: TriWest Medicare	$1,134.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,132.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,275.84

RECHARGER KIT

Facility

$7,088.00

Hospital Charge Code	27400597
Hospital Revenue Code	270
Min. Negotiated Rate	$1,842.88
Max. Negotiated Rate	$6,379.20
Rate for Payer: Aetna of AZ Commercial	$6,379.20
Rate for Payer: Bisbee Police All Plans	$1,842.88
Rate for Payer: Cash Price	$5,670.40
Rate for Payer: Self Pay Self Pay	$5,670.40

RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF

Facility

$2,375.00

Service Code	CPT 28238
Hospital Charge Code	24043294
Hospital Revenue Code	360
Min. Negotiated Rate	$380.00
Max. Negotiated Rate	$4,542.09
Rate for Payer: Aetna of AZ Commercial	$2,137.50
Rate for Payer: Aetna of AZ Medicare	$665.00
Rate for Payer: AHCCCS Medicaid	$4,542.09
Rate for Payer: Allwell Medicaid	$4,542.09
Rate for Payer: Allwell Medicare	$380.00
Rate for Payer: Amerigroup Medicare	$380.00
Rate for Payer: APIPA Medicare/Medicaid	$887.06
Rate for Payer: AZCH Complete Medicaid	$4,542.09
Rate for Payer: AZCH Complete Medicare	$380.00
Rate for Payer: Banner UC Health Medicaid	$4,542.09
Rate for Payer: Banner UC Health Medicare	$380.00
Rate for Payer: Bisbee Police All Plans	$617.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,615.00
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Cigna of AZ Commercial	$1,187.50
Rate for Payer: Copperpoint Commercial	$587.81
Rate for Payer: Health Net of AZ Commercial	$1,425.00
Rate for Payer: Health Net of AZ Medicare	$665.00
Rate for Payer: Humana of AZ Medicare	$380.00
Rate for Payer: Mercy Care Medicaid	$4,542.09
Rate for Payer: Self Pay Self Pay	$1,900.00
Rate for Payer: TriWest Medicare	$380.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,384.62
Rate for Payer: UnitedHealth Group of AZ Medicare	$427.50

RECONSTRUCTION (ADVANCEMENT) POSTERIOR TIBIAL TENDON WITH EXCISION OF

Facility

$2,375.00

Service Code	CPT 28238
Hospital Charge Code	24043294
Hospital Revenue Code	360
Min. Negotiated Rate	$617.50
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna of AZ Commercial	$2,137.50
Rate for Payer: Bisbee Police All Plans	$617.50
Rate for Payer: Cash Price	$1,900.00
Rate for Payer: Self Pay Self Pay	$1,900.00

RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY

Facility

$1,644.00

Service Code	CPT 28313
Hospital Charge Code	24043320
Hospital Revenue Code	360
Min. Negotiated Rate	$427.44
Max. Negotiated Rate	$1,479.60
Rate for Payer: Aetna of AZ Commercial	$1,479.60
Rate for Payer: Bisbee Police All Plans	$427.44
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Self Pay Self Pay	$1,315.20

RECONSTRUCTION ANGULAR DEFORMITY OF TOE SOFT TISSUE PROCEDURES ONLY

Facility

$1,644.00

Service Code	CPT 28313
Hospital Charge Code	24043320
Hospital Revenue Code	360
Min. Negotiated Rate	$263.04
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,479.60
Rate for Payer: Aetna of AZ Medicare	$460.32
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$263.04
Rate for Payer: Amerigroup Medicare	$263.04
Rate for Payer: APIPA Medicare/Medicaid	$614.03
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$263.04
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$263.04
Rate for Payer: Bisbee Police All Plans	$427.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,117.92
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cigna of AZ Commercial	$822.00
Rate for Payer: Copperpoint Commercial	$406.89
Rate for Payer: Health Net of AZ Commercial	$986.40
Rate for Payer: Health Net of AZ Medicare	$460.32
Rate for Payer: Humana of AZ Medicare	$263.04
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$1,315.20
Rate for Payer: TriWest Medicare	$263.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$295.92

Rectovaginal Fistula closure abdominal

Facility

$5,324.00

Service Code	CPT 57305
Hospital Charge Code	27291797
Hospital Revenue Code	360
Min. Negotiated Rate	$851.84
Max. Negotiated Rate	$4,791.60
Rate for Payer: Aetna of AZ Commercial	$4,791.60
Rate for Payer: Aetna of AZ Medicare	$1,490.72
Rate for Payer: Allwell Medicare	$851.84
Rate for Payer: Amerigroup Medicare	$851.84
Rate for Payer: APIPA Medicare/Medicaid	$1,988.51
Rate for Payer: AZCH Complete Medicare	$851.84
Rate for Payer: Banner UC Health Medicare	$851.84
Rate for Payer: Bisbee Police All Plans	$1,384.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,620.32
Rate for Payer: Cash Price	$4,259.20
Rate for Payer: Cash Price	$4,259.20
Rate for Payer: Cigna of AZ Commercial	$2,662.00
Rate for Payer: Copperpoint Commercial	$1,317.69
Rate for Payer: Health Net of AZ Commercial	$3,194.40
Rate for Payer: Health Net of AZ Medicare	$1,490.72
Rate for Payer: Humana of AZ Medicare	$851.84
Rate for Payer: Self Pay Self Pay	$4,259.20
Rate for Payer: TriWest Medicare	$851.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$958.32

Rectovaginal Fistula closure abdominal

Facility

$5,324.00

Service Code	CPT 57305
Hospital Charge Code	27291797
Hospital Revenue Code	360
Min. Negotiated Rate	$1,384.24
Max. Negotiated Rate	$4,791.60
Rate for Payer: Aetna of AZ Commercial	$4,791.60
Rate for Payer: Bisbee Police All Plans	$1,384.24
Rate for Payer: Cash Price	$4,259.20
Rate for Payer: Self Pay Self Pay	$4,259.20

Rectovaginal Fistula closure vaginal

Facility

$3,287.00

Service Code	CPT 57300
Hospital Charge Code	27291796
Hospital Revenue Code	360
Min. Negotiated Rate	$854.62
Max. Negotiated Rate	$2,958.30
Rate for Payer: Aetna of AZ Commercial	$2,958.30
Rate for Payer: Bisbee Police All Plans	$854.62
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Self Pay Self Pay	$2,629.60

Rectovaginal Fistula closure vaginal

Facility

$3,287.00

Service Code	CPT 57300
Hospital Charge Code	27291796
Hospital Revenue Code	360
Min. Negotiated Rate	$525.92
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$2,958.30
Rate for Payer: Aetna of AZ Medicare	$920.36
Rate for Payer: AHCCCS Medicaid	$1,901.83
Rate for Payer: Allwell Medicaid	$1,901.83
Rate for Payer: Allwell Medicare	$525.92
Rate for Payer: Amerigroup Medicare	$525.92
Rate for Payer: APIPA Medicare/Medicaid	$1,227.69
Rate for Payer: AZCH Complete Medicaid	$1,901.83
Rate for Payer: AZCH Complete Medicare	$525.92
Rate for Payer: Banner UC Health Medicaid	$1,901.83
Rate for Payer: Banner UC Health Medicare	$525.92
Rate for Payer: Bisbee Police All Plans	$854.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,235.16
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cigna of AZ Commercial	$1,643.50
Rate for Payer: Copperpoint Commercial	$813.53
Rate for Payer: Health Net of AZ Commercial	$1,972.20
Rate for Payer: Health Net of AZ Medicare	$920.36
Rate for Payer: Humana of AZ Medicare	$525.92
Rate for Payer: Mercy Care Medicaid	$1,901.83
Rate for Payer: Self Pay Self Pay	$2,629.60
Rate for Payer: TriWest Medicare	$525.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$591.66

Know your out-of-pocket cost for care.

All Charges