Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CLIENT DRUG SCREEN NON DOT 10 PANEL

Facility

$80.00

Service Code	CPT 80100
Hospital Charge Code	22331243
Hospital Revenue Code	301
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Aetna of AZ Medicare	$22.40
Rate for Payer: Allwell Medicare	$12.00
Rate for Payer: Amerigroup Medicare	$12.00
Rate for Payer: APIPA Medicare/Medicaid	$29.88
Rate for Payer: AZCH Complete Medicare	$12.00
Rate for Payer: Banner UC Health Medicare	$12.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$54.40
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cigna of AZ Commercial	$52.00
Rate for Payer: Copperpoint Commercial	$19.80
Rate for Payer: Health Net of AZ Commercial	$48.00
Rate for Payer: Health Net of AZ Medicare	$22.40
Rate for Payer: Humana of AZ Medicare	$12.00
Rate for Payer: Self Pay Self Pay	$64.00
Rate for Payer: TriWest Medicare	$12.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.40

CLIENT DRUG SCREEN NON DOT 10 PANEL

Facility

$80.00

Service Code	CPT 80100
Hospital Charge Code	22331243
Hospital Revenue Code	301
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of AZ Commercial	$72.00
Rate for Payer: Bisbee Police All Plans	$20.80
Rate for Payer: Cash Price	$64.00
Rate for Payer: Self Pay Self Pay	$64.00

CLIENT DRUG SCREEN NON DOT 5 PANEL

Facility

$63.00

Service Code	CPT 80100
Hospital Charge Code	22331244
Hospital Revenue Code	301
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Aetna of AZ Medicare	$17.64
Rate for Payer: Allwell Medicare	$9.45
Rate for Payer: Amerigroup Medicare	$9.45
Rate for Payer: APIPA Medicare/Medicaid	$23.53
Rate for Payer: AZCH Complete Medicare	$9.45
Rate for Payer: Banner UC Health Medicare	$9.45
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.84
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna of AZ Commercial	$40.95
Rate for Payer: Copperpoint Commercial	$15.59
Rate for Payer: Health Net of AZ Commercial	$37.80
Rate for Payer: Health Net of AZ Medicare	$17.64
Rate for Payer: Humana of AZ Medicare	$9.45
Rate for Payer: Self Pay Self Pay	$50.40
Rate for Payer: TriWest Medicare	$9.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.34

CLIENT DRUG SCREEN NON DOT 5 PANEL

Facility

$63.00

Service Code	CPT 80100
Hospital Charge Code	22331244
Hospital Revenue Code	301
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$56.70
Rate for Payer: Aetna of AZ Commercial	$56.70
Rate for Payer: Bisbee Police All Plans	$16.38
Rate for Payer: Cash Price	$50.40
Rate for Payer: Self Pay Self Pay	$50.40

CLIENT DRUG SCREEN RAPID

Facility

$55.00

Service Code	CPT 80100
Hospital Charge Code	22331245
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Aetna of AZ Medicare	$15.40
Rate for Payer: Allwell Medicare	$8.25
Rate for Payer: Amerigroup Medicare	$8.25
Rate for Payer: APIPA Medicare/Medicaid	$20.54
Rate for Payer: AZCH Complete Medicare	$8.25
Rate for Payer: Banner UC Health Medicare	$8.25
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$37.40
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cigna of AZ Commercial	$35.75
Rate for Payer: Copperpoint Commercial	$13.61
Rate for Payer: Health Net of AZ Commercial	$33.00
Rate for Payer: Health Net of AZ Medicare	$15.40
Rate for Payer: Humana of AZ Medicare	$8.25
Rate for Payer: Self Pay Self Pay	$44.00
Rate for Payer: TriWest Medicare	$8.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$32.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.90

CLIENT DRUG SCREEN RAPID

Facility

$55.00

Service Code	CPT 80100
Hospital Charge Code	22331245
Hospital Revenue Code	301
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna of AZ Commercial	$49.50
Rate for Payer: Bisbee Police All Plans	$14.30
Rate for Payer: Cash Price	$44.00
Rate for Payer: Self Pay Self Pay	$44.00

CLIENT EKG (12 LEAD)

Facility

$230.00

Service Code	CPT 93005
Hospital Charge Code	22331249
Hospital Revenue Code	730
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: AHCCCS Medicaid	$51.98
Rate for Payer: Allwell Medicaid	$51.98
Rate for Payer: Allwell Medicare	$34.50
Rate for Payer: Amerigroup Medicare	$34.50
Rate for Payer: APIPA Medicare/Medicaid	$85.90
Rate for Payer: AZCH Complete Medicaid	$51.98
Rate for Payer: AZCH Complete Medicare	$34.50
Rate for Payer: Banner UC Health Medicaid	$51.98
Rate for Payer: Banner UC Health Medicare	$34.50
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$161.00
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$34.50
Rate for Payer: Mercy Care Medicaid	$51.98
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$34.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

CLIENT EKG (12 LEAD)

Facility

$230.00

Service Code	CPT 93005
Hospital Charge Code	22331249
Hospital Revenue Code	730
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

CLIENT EKG TRACING W/O INTERP

Facility

$39.00

Service Code	CPT 93041
Hospital Charge Code	22331254
Hospital Revenue Code	730
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

CLIENT EKG TRACING W/O INTERP

Facility

$39.00

Service Code	CPT 93041
Hospital Charge Code	22331254
Hospital Revenue Code	730
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$80.70
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: AHCCCS Medicaid	$80.70
Rate for Payer: Allwell Medicaid	$80.70
Rate for Payer: Allwell Medicare	$5.85
Rate for Payer: Amerigroup Medicare	$5.85
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicaid	$80.70
Rate for Payer: AZCH Complete Medicare	$5.85
Rate for Payer: Banner UC Health Medicaid	$80.70
Rate for Payer: Banner UC Health Medicare	$5.85
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$27.30
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$5.85
Rate for Payer: Mercy Care Medicaid	$80.70
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$5.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

CLIENT FLU VACCINE ADULT 0.5 ML

Facility

$97.00

Hospital Charge Code	22331274
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$14.55
Rate for Payer: Banner UC Health Medicare	$14.55
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$63.05
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$14.55
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$14.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

CLIENT FLU VACCINE ADULT 0.5 ML

Facility

$97.00

Hospital Charge Code	22331274
Hospital Revenue Code	250
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

CLIENT HAIR FOLLICLE TEST

Facility

$30.00

Hospital Charge Code	22331294
Hospital Revenue Code	302
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

CLIENT HAIR FOLLICLE TEST

Facility

$30.00

Hospital Charge Code	22331294
Hospital Revenue Code	302
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

CLIENT HEP B IMMUNIZATION

Facility

$75.00

Service Code	CPT 90636
Hospital Charge Code	22331305
Hospital Revenue Code	636
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Cash Price	$60.00
Rate for Payer: Self Pay Self Pay	$60.00

CLIENT HEP B IMMUNIZATION

Facility

$75.00

Service Code	CPT 90636
Hospital Charge Code	22331305
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$234.78
Rate for Payer: Aetna of AZ Commercial	$67.50
Rate for Payer: Aetna of AZ Medicare	$21.00
Rate for Payer: AHCCCS Medicaid	$234.78
Rate for Payer: Allwell Medicaid	$234.78
Rate for Payer: Allwell Medicare	$11.25
Rate for Payer: Amerigroup Medicare	$11.25
Rate for Payer: APIPA Medicare/Medicaid	$28.01
Rate for Payer: AZCH Complete Medicaid	$234.78
Rate for Payer: AZCH Complete Medicare	$11.25
Rate for Payer: Banner UC Health Medicaid	$234.78
Rate for Payer: Banner UC Health Medicare	$11.25
Rate for Payer: Bisbee Police All Plans	$19.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cigna of AZ Commercial	$52.50
Rate for Payer: Copperpoint Commercial	$18.56
Rate for Payer: Health Net of AZ Commercial	$45.00
Rate for Payer: Health Net of AZ Medicare	$21.00
Rate for Payer: Humana of AZ Medicare	$11.25
Rate for Payer: Mercy Care Medicaid	$234.78
Rate for Payer: Self Pay Self Pay	$60.00
Rate for Payer: TriWest Medicare	$11.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$43.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.50

CLIENT HIP COMPLETE BILATERAL

Facility

$41.33

Service Code	CPT 73521
Hospital Charge Code	22331313
Hospital Revenue Code	320
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$37.20
Rate for Payer: Aetna of AZ Commercial	$37.20
Rate for Payer: Bisbee Police All Plans	$10.75
Rate for Payer: Cash Price	$33.06
Rate for Payer: Self Pay Self Pay	$33.06

CLIENT HIP COMPLETE BILATERAL

Facility

$41.33

Service Code	CPT 73521
Hospital Charge Code	22331313
Hospital Revenue Code	320
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$158.00
Rate for Payer: Aetna of AZ Commercial	$37.20
Rate for Payer: Aetna of AZ Medicare	$11.57
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$6.20
Rate for Payer: Amerigroup Medicare	$6.20
Rate for Payer: APIPA Medicare/Medicaid	$15.44
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$6.20
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$6.20
Rate for Payer: Bisbee Police All Plans	$10.75
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.10
Rate for Payer: Cash Price	$33.06
Rate for Payer: Cash Price	$33.06
Rate for Payer: Cigna of AZ Commercial	$26.86
Rate for Payer: Copperpoint Commercial	$10.23
Rate for Payer: Health Net of AZ Commercial	$24.80
Rate for Payer: Health Net of AZ Medicare	$11.57
Rate for Payer: Humana of AZ Medicare	$6.20
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$33.06
Rate for Payer: TriWest Medicare	$6.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.44

CLIENT HIV

Facility

$48.00

Service Code	CPT 86701
Hospital Charge Code	22331316
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Aetna of AZ Medicare	$13.44
Rate for Payer: AHCCCS Medicaid	$8.89
Rate for Payer: Allwell Medicaid	$8.89
Rate for Payer: Allwell Medicare	$7.20
Rate for Payer: Amerigroup Medicare	$7.20
Rate for Payer: APIPA Medicare/Medicaid	$17.93
Rate for Payer: AZCH Complete Medicaid	$8.89
Rate for Payer: AZCH Complete Medicare	$7.20
Rate for Payer: Banner UC Health Medicaid	$8.89
Rate for Payer: Banner UC Health Medicare	$7.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$32.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cigna of AZ Commercial	$31.20
Rate for Payer: Copperpoint Commercial	$11.88
Rate for Payer: Health Net of AZ Commercial	$28.80
Rate for Payer: Health Net of AZ Medicare	$13.44
Rate for Payer: Humana of AZ Medicare	$7.20
Rate for Payer: Mercy Care Medicaid	$8.89
Rate for Payer: Self Pay Self Pay	$38.40
Rate for Payer: TriWest Medicare	$7.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.64

CLIENT HIV

Facility

$48.00

Service Code	CPT 86701
Hospital Charge Code	22331316
Hospital Revenue Code	302
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of AZ Commercial	$43.20
Rate for Payer: Bisbee Police All Plans	$12.48
Rate for Payer: Cash Price	$38.40
Rate for Payer: Self Pay Self Pay	$38.40

CLIENT INCENTIVE SPIROMTRY

Facility

$165.00

Service Code	CPT 94799
Hospital Charge Code	22331327
Hospital Revenue Code	412
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$202.34
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Aetna of AZ Medicare	$46.20
Rate for Payer: AHCCCS Medicaid	$202.34
Rate for Payer: Allwell Medicaid	$202.34
Rate for Payer: Allwell Medicare	$24.75
Rate for Payer: Amerigroup Medicare	$24.75
Rate for Payer: APIPA Medicare/Medicaid	$61.63
Rate for Payer: AZCH Complete Medicaid	$202.34
Rate for Payer: AZCH Complete Medicare	$24.75
Rate for Payer: Banner UC Health Medicaid	$202.34
Rate for Payer: Banner UC Health Medicare	$24.75
Rate for Payer: Bisbee Police All Plans	$42.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$112.20
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cigna of AZ Commercial	$115.50
Rate for Payer: Copperpoint Commercial	$40.84
Rate for Payer: Health Net of AZ Commercial	$99.00
Rate for Payer: Health Net of AZ Medicare	$46.20
Rate for Payer: Humana of AZ Medicare	$24.75
Rate for Payer: Mercy Care Medicaid	$202.34
Rate for Payer: Self Pay Self Pay	$132.00
Rate for Payer: TriWest Medicare	$24.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$96.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.70

CLIENT INCENTIVE SPIROMTRY

Facility

$165.00

Service Code	CPT 94799
Hospital Charge Code	22331327
Hospital Revenue Code	412
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna of AZ Commercial	$148.50
Rate for Payer: Bisbee Police All Plans	$42.90
Rate for Payer: Cash Price	$132.00
Rate for Payer: Self Pay Self Pay	$132.00

CLIENT INFLUENZA A SCREEN (RAPID)

Facility

$130.00

Service Code	CPT 87804
Hospital Charge Code	22331329
Hospital Revenue Code	306
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

CLIENT INFLUENZA A SCREEN (RAPID)

Facility

$130.00

Service Code	CPT 87804
Hospital Charge Code	22331329
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: AHCCCS Medicaid	$16.55
Rate for Payer: Allwell Medicaid	$16.55
Rate for Payer: Allwell Medicare	$19.50
Rate for Payer: Amerigroup Medicare	$19.50
Rate for Payer: APIPA Medicare/Medicaid	$48.56
Rate for Payer: AZCH Complete Medicaid	$16.55
Rate for Payer: AZCH Complete Medicare	$19.50
Rate for Payer: Banner UC Health Medicaid	$16.55
Rate for Payer: Banner UC Health Medicare	$19.50
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.18
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$19.50
Rate for Payer: Mercy Care Medicaid	$16.55
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$19.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

CLIENT IV-LACTATED RINGERS : 1000 ML

Facility

$30.00

Hospital Charge Code	22331338
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

Know your out-of-pocket cost for care.

All Charges