Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Colposcopy of the entire vagina with cervix with biopsies of

Facility

$3,135.00

Service Code	CPT 57421
Hospital Charge Code	22664755
Hospital Revenue Code	750
Min. Negotiated Rate	$459.22
Max. Negotiated Rate	$2,821.50
Rate for Payer: Aetna of AZ Commercial	$2,821.50
Rate for Payer: Aetna of AZ Medicare	$877.80
Rate for Payer: AHCCCS Medicaid	$459.22
Rate for Payer: Allwell Medicaid	$459.22
Rate for Payer: Allwell Medicare	$501.60
Rate for Payer: Amerigroup Medicare	$501.60
Rate for Payer: APIPA Medicare/Medicaid	$1,170.92
Rate for Payer: AZCH Complete Medicaid	$459.22
Rate for Payer: AZCH Complete Medicare	$501.60
Rate for Payer: Banner UC Health Medicaid	$459.22
Rate for Payer: Banner UC Health Medicare	$501.60
Rate for Payer: Bisbee Police All Plans	$815.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,131.80
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Cigna of AZ Commercial	$2,194.50
Rate for Payer: Copperpoint Commercial	$775.91
Rate for Payer: Health Net of AZ Commercial	$1,881.00
Rate for Payer: Health Net of AZ Medicare	$877.80
Rate for Payer: Humana of AZ Medicare	$501.60
Rate for Payer: Mercy Care Medicaid	$459.22
Rate for Payer: Self Pay Self Pay	$2,508.00
Rate for Payer: TriWest Medicare	$501.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$564.30

Colposcopy of the entire vagina with cervix with biopsies of

Facility

$3,135.00

Service Code	CPT 57421
Hospital Charge Code	22664755
Hospital Revenue Code	750
Min. Negotiated Rate	$815.10
Max. Negotiated Rate	$2,821.50
Rate for Payer: Aetna of AZ Commercial	$2,821.50
Rate for Payer: Bisbee Police All Plans	$815.10
Rate for Payer: Cash Price	$2,508.00
Rate for Payer: Self Pay Self Pay	$2,508.00

Complement C3, Serum LC

Facility

$258.00

Service Code	CPT 86160
Hospital Charge Code	1285557
Hospital Revenue Code	302
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

Complement C3, Serum LC

Facility

$258.00

Service Code	CPT 86160
Hospital Charge Code	1285557
Hospital Revenue Code	302
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: Allwell Medicare	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicare	$41.28
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$167.70
Rate for Payer: Copperpoint Commercial	$63.85
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

Complement C4, Serum LC

Facility

$258.00

Service Code	CPT 86160
Hospital Charge Code	1285559
Hospital Revenue Code	302
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

Complement C4, Serum LC

Facility

$258.00

Service Code	CPT 86160
Hospital Charge Code	1285559
Hospital Revenue Code	302
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: Allwell Medicare	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicare	$41.28
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$167.70
Rate for Payer: Copperpoint Commercial	$63.85
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

Complement, Total (CH50) LC

Facility

$309.00

Service Code	CPT 86162
Hospital Charge Code	1906808
Hospital Revenue Code	302
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Cash Price	$247.20
Rate for Payer: Self Pay Self Pay	$247.20

Complement, Total (CH50) LC

Facility

$309.00

Service Code	CPT 86162
Hospital Charge Code	1906808
Hospital Revenue Code	302
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$278.10
Rate for Payer: Aetna of AZ Commercial	$278.10
Rate for Payer: Aetna of AZ Medicare	$86.52
Rate for Payer: Allwell Medicare	$49.44
Rate for Payer: Amerigroup Medicare	$49.44
Rate for Payer: APIPA Medicare/Medicaid	$115.41
Rate for Payer: AZCH Complete Medicare	$49.44
Rate for Payer: Banner UC Health Medicare	$49.44
Rate for Payer: Bisbee Police All Plans	$80.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.12
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cigna of AZ Commercial	$200.85
Rate for Payer: Copperpoint Commercial	$76.48
Rate for Payer: Health Net of AZ Commercial	$185.40
Rate for Payer: Health Net of AZ Medicare	$86.52
Rate for Payer: Humana of AZ Medicare	$49.44
Rate for Payer: Self Pay Self Pay	$247.20
Rate for Payer: TriWest Medicare	$49.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.62

Complete Blood Count/Hemogram Standard

Facility

$170.00

Service Code	CPT 85025
Hospital Charge Code	22141055
Hospital Revenue Code	305
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Cash Price	$136.00
Rate for Payer: Self Pay Self Pay	$136.00

Complete Blood Count/Hemogram Standard

Facility

$170.00

Service Code	CPT 85025
Hospital Charge Code	22141055
Hospital Revenue Code	305
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Aetna of AZ Medicare	$47.60
Rate for Payer: Allwell Medicare	$27.20
Rate for Payer: Amerigroup Medicare	$27.20
Rate for Payer: APIPA Medicare/Medicaid	$63.49
Rate for Payer: AZCH Complete Medicare	$27.20
Rate for Payer: Banner UC Health Medicare	$27.20
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$115.60
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cigna of AZ Commercial	$110.50
Rate for Payer: Copperpoint Commercial	$42.08
Rate for Payer: Health Net of AZ Commercial	$102.00
Rate for Payer: Health Net of AZ Medicare	$47.60
Rate for Payer: Humana of AZ Medicare	$27.20
Rate for Payer: Self Pay Self Pay	$136.00
Rate for Payer: TriWest Medicare	$27.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$99.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.60

COMPLETE LASER FRAGMENTATION OF PROSTATE INCLUDING CONTROL O

Facility

$4,322.00

Service Code	CPT 52649
Hospital Charge Code	27881571
Hospital Revenue Code	360
Min. Negotiated Rate	$1,123.72
Max. Negotiated Rate	$3,889.80
Rate for Payer: Aetna of AZ Commercial	$3,889.80
Rate for Payer: Bisbee Police All Plans	$1,123.72
Rate for Payer: Cash Price	$3,457.60
Rate for Payer: Self Pay Self Pay	$3,457.60

COMPLETE LASER FRAGMENTATION OF PROSTATE INCLUDING CONTROL O

Facility

$4,322.00

Service Code	CPT 52649
Hospital Charge Code	27881571
Hospital Revenue Code	360
Min. Negotiated Rate	$691.52
Max. Negotiated Rate	$3,889.80
Rate for Payer: Aetna of AZ Commercial	$3,889.80
Rate for Payer: Aetna of AZ Medicare	$1,210.16
Rate for Payer: AHCCCS Medicaid	$3,200.08
Rate for Payer: Allwell Medicaid	$3,200.08
Rate for Payer: Allwell Medicare	$691.52
Rate for Payer: Amerigroup Medicare	$691.52
Rate for Payer: APIPA Medicare/Medicaid	$1,614.27
Rate for Payer: AZCH Complete Medicaid	$3,200.08
Rate for Payer: AZCH Complete Medicare	$691.52
Rate for Payer: Banner UC Health Medicaid	$3,200.08
Rate for Payer: Banner UC Health Medicare	$691.52
Rate for Payer: Bisbee Police All Plans	$1,123.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,938.96
Rate for Payer: Cash Price	$3,457.60
Rate for Payer: Cash Price	$3,457.60
Rate for Payer: Cigna of AZ Commercial	$2,161.00
Rate for Payer: Copperpoint Commercial	$1,069.69
Rate for Payer: Health Net of AZ Commercial	$2,593.20
Rate for Payer: Health Net of AZ Medicare	$1,210.16
Rate for Payer: Humana of AZ Medicare	$691.52
Rate for Payer: Mercy Care Medicaid	$3,200.08
Rate for Payer: Self Pay Self Pay	$3,457.60
Rate for Payer: TriWest Medicare	$691.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,519.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$777.96

COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT

Facility

$2,113.00

Service Code	CPT 52630
Hospital Charge Code	27797699
Hospital Revenue Code	360
Min. Negotiated Rate	$549.38
Max. Negotiated Rate	$1,901.70
Rate for Payer: Aetna of AZ Commercial	$1,901.70
Rate for Payer: Bisbee Police All Plans	$549.38
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Self Pay Self Pay	$1,690.40

COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT

Facility

$2,113.00

Service Code	CPT 52630
Hospital Charge Code	27797699
Hospital Revenue Code	360
Min. Negotiated Rate	$338.08
Max. Negotiated Rate	$3,200.08
Rate for Payer: Aetna of AZ Commercial	$1,901.70
Rate for Payer: Aetna of AZ Medicare	$591.64
Rate for Payer: AHCCCS Medicaid	$3,200.08
Rate for Payer: Allwell Medicaid	$3,200.08
Rate for Payer: Allwell Medicare	$338.08
Rate for Payer: Amerigroup Medicare	$338.08
Rate for Payer: APIPA Medicare/Medicaid	$789.21
Rate for Payer: AZCH Complete Medicaid	$3,200.08
Rate for Payer: AZCH Complete Medicare	$338.08
Rate for Payer: Banner UC Health Medicaid	$3,200.08
Rate for Payer: Banner UC Health Medicare	$338.08
Rate for Payer: Bisbee Police All Plans	$549.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,436.84
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Cigna of AZ Commercial	$1,056.50
Rate for Payer: Copperpoint Commercial	$522.97
Rate for Payer: Health Net of AZ Commercial	$1,267.80
Rate for Payer: Health Net of AZ Medicare	$591.64
Rate for Payer: Humana of AZ Medicare	$338.08
Rate for Payer: Mercy Care Medicaid	$3,200.08
Rate for Payer: Self Pay Self Pay	$1,690.40
Rate for Payer: TriWest Medicare	$338.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,231.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$380.34

COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT

Facility

$2,113.00

Service Code	CPT 52630
Hospital Charge Code	27803576
Hospital Revenue Code	360
Min. Negotiated Rate	$549.38
Max. Negotiated Rate	$1,901.70
Rate for Payer: Aetna of AZ Commercial	$1,901.70
Rate for Payer: Bisbee Police All Plans	$549.38
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Self Pay Self Pay	$1,690.40

COMPLETE REMOVAL OF REMAINING OR REGROWN PROSTATE TISSUE WIT

Facility

$2,113.00

Service Code	CPT 52630
Hospital Charge Code	27803576
Hospital Revenue Code	360
Min. Negotiated Rate	$338.08
Max. Negotiated Rate	$3,200.08
Rate for Payer: Aetna of AZ Commercial	$1,901.70
Rate for Payer: Aetna of AZ Medicare	$591.64
Rate for Payer: AHCCCS Medicaid	$3,200.08
Rate for Payer: Allwell Medicaid	$3,200.08
Rate for Payer: Allwell Medicare	$338.08
Rate for Payer: Amerigroup Medicare	$338.08
Rate for Payer: APIPA Medicare/Medicaid	$789.21
Rate for Payer: AZCH Complete Medicaid	$3,200.08
Rate for Payer: AZCH Complete Medicare	$338.08
Rate for Payer: Banner UC Health Medicaid	$3,200.08
Rate for Payer: Banner UC Health Medicare	$338.08
Rate for Payer: Bisbee Police All Plans	$549.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,436.84
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Cash Price	$1,690.40
Rate for Payer: Cigna of AZ Commercial	$1,056.50
Rate for Payer: Copperpoint Commercial	$522.97
Rate for Payer: Health Net of AZ Commercial	$1,267.80
Rate for Payer: Health Net of AZ Medicare	$591.64
Rate for Payer: Humana of AZ Medicare	$338.08
Rate for Payer: Mercy Care Medicaid	$3,200.08
Rate for Payer: Self Pay Self Pay	$1,690.40
Rate for Payer: TriWest Medicare	$338.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,231.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$380.34

Complex cystometrogram (ie, calibrated electronic equipment)

Facility

$2,081.00

Service Code	CPT 51729
Hospital Charge Code	27802895
Hospital Revenue Code	360
Min. Negotiated Rate	$541.06
Max. Negotiated Rate	$1,872.90
Rate for Payer: Aetna of AZ Commercial	$1,872.90
Rate for Payer: Bisbee Police All Plans	$541.06
Rate for Payer: Cash Price	$1,664.80
Rate for Payer: Self Pay Self Pay	$1,664.80

Complex cystometrogram (ie, calibrated electronic equipment)

Facility

$2,081.00

Service Code	CPT 51729
Hospital Charge Code	27802895
Hospital Revenue Code	360
Min. Negotiated Rate	$332.96
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$1,872.90
Rate for Payer: Aetna of AZ Medicare	$582.68
Rate for Payer: AHCCCS Medicaid	$416.71
Rate for Payer: Allwell Medicaid	$416.71
Rate for Payer: Allwell Medicare	$332.96
Rate for Payer: Amerigroup Medicare	$332.96
Rate for Payer: APIPA Medicare/Medicaid	$777.25
Rate for Payer: AZCH Complete Medicaid	$416.71
Rate for Payer: AZCH Complete Medicare	$332.96
Rate for Payer: Banner UC Health Medicaid	$416.71
Rate for Payer: Banner UC Health Medicare	$332.96
Rate for Payer: Bisbee Police All Plans	$541.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,415.08
Rate for Payer: Cash Price	$1,664.80
Rate for Payer: Cash Price	$1,664.80
Rate for Payer: Cigna of AZ Commercial	$1,040.50
Rate for Payer: Copperpoint Commercial	$515.05
Rate for Payer: Health Net of AZ Commercial	$1,248.60
Rate for Payer: Health Net of AZ Medicare	$582.68
Rate for Payer: Humana of AZ Medicare	$332.96
Rate for Payer: Mercy Care Medicaid	$416.71
Rate for Payer: Self Pay Self Pay	$1,664.80
Rate for Payer: TriWest Medicare	$332.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$374.58

Comprehensive Metabolic Panel Standard

Facility

$390.00

Service Code	CPT 80053
Hospital Charge Code	22141044
Hospital Revenue Code	301
Min. Negotiated Rate	$101.40
Max. Negotiated Rate	$351.00
Rate for Payer: Aetna of AZ Commercial	$351.00
Rate for Payer: Bisbee Police All Plans	$101.40
Rate for Payer: Cash Price	$312.00
Rate for Payer: Self Pay Self Pay	$312.00

Comprehensive Metabolic Panel Standard

Facility

$390.00

Service Code	CPT 80053
Hospital Charge Code	22141044
Hospital Revenue Code	301
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$351.00
Rate for Payer: Aetna of AZ Commercial	$351.00
Rate for Payer: Aetna of AZ Medicare	$109.20
Rate for Payer: Allwell Medicare	$62.40
Rate for Payer: Amerigroup Medicare	$62.40
Rate for Payer: APIPA Medicare/Medicaid	$145.66
Rate for Payer: AZCH Complete Medicare	$62.40
Rate for Payer: Banner UC Health Medicare	$62.40
Rate for Payer: Bisbee Police All Plans	$101.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$265.20
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cigna of AZ Commercial	$253.50
Rate for Payer: Copperpoint Commercial	$96.53
Rate for Payer: Health Net of AZ Commercial	$234.00
Rate for Payer: Health Net of AZ Medicare	$109.20
Rate for Payer: Humana of AZ Medicare	$62.40
Rate for Payer: Self Pay Self Pay	$312.00
Rate for Payer: TriWest Medicare	$62.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$227.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$70.20

Computer Crossmatch

Facility

$177.00

Service Code	CPT 86923
Hospital Charge Code	1681859
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

Computer Crossmatch

Facility

$177.00

Service Code	CPT 86923
Hospital Charge Code	1779651
Hospital Revenue Code	302
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Aetna of AZ Medicare	$49.56
Rate for Payer: Allwell Medicare	$28.32
Rate for Payer: Amerigroup Medicare	$28.32
Rate for Payer: APIPA Medicare/Medicaid	$66.11
Rate for Payer: AZCH Complete Medicare	$28.32
Rate for Payer: Banner UC Health Medicare	$28.32
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$120.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cigna of AZ Commercial	$115.05
Rate for Payer: Copperpoint Commercial	$43.81
Rate for Payer: Health Net of AZ Commercial	$106.20
Rate for Payer: Health Net of AZ Medicare	$49.56
Rate for Payer: Humana of AZ Medicare	$28.32
Rate for Payer: Self Pay Self Pay	$141.60
Rate for Payer: TriWest Medicare	$28.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.86

Computer Crossmatch

Facility

$177.00

Service Code	CPT 86923
Hospital Charge Code	1681859
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

Computer Crossmatch

Facility

$177.00

Service Code	CPT 86923
Hospital Charge Code	1779651
Hospital Revenue Code	302
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$159.30
Rate for Payer: Aetna of AZ Commercial	$159.30
Rate for Payer: Bisbee Police All Plans	$46.02
Rate for Payer: Cash Price	$141.60
Rate for Payer: Self Pay Self Pay	$141.60

CONCENTRATION INFECT AGENT

Facility

$81.00

Service Code	CPT 87015
Hospital Charge Code	22422557
Hospital Revenue Code	306
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$72.90
Rate for Payer: Aetna of AZ Commercial	$72.90
Rate for Payer: Bisbee Police All Plans	$21.06
Rate for Payer: Cash Price	$64.80
Rate for Payer: Self Pay Self Pay	$64.80

Know your out-of-pocket cost for care.

All Charges