Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

XR Finger 2nd Digit Right

Facility

$488.00

Service Code	CPT 73140 F6
Hospital Charge Code	823534
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 3rd Digit Left

Facility

$488.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 3rd Digit Left

Facility

$488.00

Service Code	CPT 73140 F2
Hospital Charge Code	823536
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 3rd Digit Right

Facility

$488.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 3rd Digit Right

Facility

$488.00

Service Code	CPT 73140 F7
Hospital Charge Code	823538
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 4th Digit Left

Facility

$488.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 4th Digit Left

Facility

$488.00

Service Code	CPT 73140 F3
Hospital Charge Code	823540
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 4th Digit Right

Facility

$488.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 4th Digit Right

Facility

$488.00

Service Code	CPT 73140 F8
Hospital Charge Code	823542
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 5th Digit Left

Facility

$488.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 5th Digit Left

Facility

$488.00

Service Code	CPT 73140 F4
Hospital Charge Code	823544
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger 5th Digit Right

Facility

$488.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger 5th Digit Right

Facility

$488.00

Service Code	CPT 73140 F9
Hospital Charge Code	823546
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger Thumb Left

Facility

$488.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger Thumb Left

Facility

$488.00

Service Code	CPT 73140 FA
Hospital Charge Code	823548
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Finger Thumb Right

Facility

$488.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Finger Thumb Right

Facility

$488.00

Service Code	CPT 73140 F5
Hospital Charge Code	823550
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$224.38
Max. Negotiated Rate	$776.70
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Bisbee Police All Plans	$224.38
Rate for Payer: Cash Price	$690.40
Rate for Payer: Self Pay Self Pay	$690.40

XR Fistula or Sinus Tract Abscess Study

Facility

$863.00

Service Code	CPT 76080
Hospital Charge Code	1007948
Hospital Revenue Code	320
Min. Negotiated Rate	$129.45
Max. Negotiated Rate	$776.70
Rate for Payer: Aetna of AZ Commercial	$776.70
Rate for Payer: Aetna of AZ Medicare	$241.64
Rate for Payer: AHCCCS Medicaid	$700.20
Rate for Payer: Allwell Medicaid	$700.20
Rate for Payer: Allwell Medicare	$129.45
Rate for Payer: Amerigroup Medicare	$129.45
Rate for Payer: APIPA Medicare/Medicaid	$322.33
Rate for Payer: AZCH Complete Medicaid	$700.20
Rate for Payer: AZCH Complete Medicare	$129.45
Rate for Payer: Banner UC Health Medicaid	$700.20
Rate for Payer: Banner UC Health Medicare	$129.45
Rate for Payer: Bisbee Police All Plans	$224.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$586.84
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cigna of AZ Commercial	$560.95
Rate for Payer: Copperpoint Commercial	$213.59
Rate for Payer: Health Net of AZ Commercial	$517.80
Rate for Payer: Health Net of AZ Medicare	$241.64
Rate for Payer: Humana of AZ Medicare	$129.45
Rate for Payer: Mercy Care Medicaid	$700.20
Rate for Payer: Self Pay Self Pay	$690.40
Rate for Payer: TriWest Medicare	$129.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$503.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.34

XR Fluoroscopy Up to 1 Hour

Facility

$680.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Self Pay Self Pay	$544.00

XR Fluoroscopy Up to 1 Hour

Facility

$680.00

Service Code	CPT 76000
Hospital Charge Code	823552
Hospital Revenue Code	320
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna of AZ Commercial	$612.00
Rate for Payer: Aetna of AZ Medicare	$190.40
Rate for Payer: AHCCCS Medicaid	$333.68
Rate for Payer: Allwell Medicaid	$333.68
Rate for Payer: Allwell Medicare	$102.00
Rate for Payer: Amerigroup Medicare	$102.00
Rate for Payer: APIPA Medicare/Medicaid	$253.98
Rate for Payer: AZCH Complete Medicaid	$333.68
Rate for Payer: AZCH Complete Medicare	$102.00
Rate for Payer: Banner UC Health Medicaid	$333.68
Rate for Payer: Banner UC Health Medicare	$102.00
Rate for Payer: Bisbee Police All Plans	$176.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$462.40
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cigna of AZ Commercial	$442.00
Rate for Payer: Copperpoint Commercial	$168.30
Rate for Payer: Health Net of AZ Commercial	$408.00
Rate for Payer: Health Net of AZ Medicare	$190.40
Rate for Payer: Humana of AZ Medicare	$102.00
Rate for Payer: Mercy Care Medicaid	$333.68
Rate for Payer: Self Pay Self Pay	$544.00
Rate for Payer: TriWest Medicare	$102.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$396.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.40

XR Foot 2 Views Left

Facility

$488.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

XR Foot 2 Views Left

Facility

$488.00

Service Code	CPT 73620 LT
Hospital Charge Code	823554
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Foot 2 Views Right

Facility

$488.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
Hospital Revenue Code	320
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Cash Price	$390.40
Rate for Payer: Self Pay Self Pay	$390.40

XR Foot 2 Views Right

Facility

$488.00

Service Code	CPT 73620 RT
Hospital Charge Code	823556
Hospital Revenue Code	320
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$439.20
Rate for Payer: Aetna of AZ Commercial	$439.20
Rate for Payer: Aetna of AZ Medicare	$136.64
Rate for Payer: Allwell Medicare	$73.20
Rate for Payer: Amerigroup Medicare	$73.20
Rate for Payer: APIPA Medicare/Medicaid	$182.27
Rate for Payer: AZCH Complete Medicare	$73.20
Rate for Payer: Banner UC Health Medicare	$73.20
Rate for Payer: Bisbee Police All Plans	$126.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$331.84
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cigna of AZ Commercial	$317.20
Rate for Payer: Copperpoint Commercial	$120.78
Rate for Payer: Health Net of AZ Commercial	$292.80
Rate for Payer: Health Net of AZ Medicare	$136.64
Rate for Payer: Humana of AZ Medicare	$73.20
Rate for Payer: Self Pay Self Pay	$390.40
Rate for Payer: TriWest Medicare	$73.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$284.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$87.84

Know your out-of-pocket cost for care.

All Charges