Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CRUTCH YOUTH

Facility

$57.00

Service Code	CPT E0113
Hospital Charge Code	22354910
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: AHCCCS Medicaid	$32.36
Rate for Payer: Allwell Medicaid	$32.36
Rate for Payer: Allwell Medicare	$8.55
Rate for Payer: Amerigroup Medicare	$8.55
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicaid	$32.36
Rate for Payer: AZCH Complete Medicare	$8.55
Rate for Payer: Banner UC Health Medicaid	$32.36
Rate for Payer: Banner UC Health Medicare	$8.55
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$8.55
Rate for Payer: Mercy Care Medicaid	$32.36
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$8.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

CRUTCH YOUTH

Facility

$57.00

Service Code	CPT E0113
Hospital Charge Code	22354910
Hospital Revenue Code	270
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

Cryo AHF

Facility

$504.00

Service Code	CPT P9044
Hospital Charge Code	1011948
Hospital Revenue Code	390
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Aetna of AZ Medicare	$141.12
Rate for Payer: AHCCCS Medicaid	$95.26
Rate for Payer: Allwell Medicaid	$95.26
Rate for Payer: Allwell Medicare	$75.60
Rate for Payer: Amerigroup Medicare	$75.60
Rate for Payer: APIPA Medicare/Medicaid	$188.24
Rate for Payer: AZCH Complete Medicaid	$95.26
Rate for Payer: AZCH Complete Medicare	$75.60
Rate for Payer: Banner UC Health Medicaid	$95.26
Rate for Payer: Banner UC Health Medicare	$75.60
Rate for Payer: Bisbee Police All Plans	$131.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$342.72
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna of AZ Commercial	$327.60
Rate for Payer: Copperpoint Commercial	$124.74
Rate for Payer: Health Net of AZ Commercial	$302.40
Rate for Payer: Health Net of AZ Medicare	$141.12
Rate for Payer: Humana of AZ Medicare	$75.60
Rate for Payer: Mercy Care Medicaid	$95.26
Rate for Payer: Self Pay Self Pay	$403.20
Rate for Payer: TriWest Medicare	$75.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$293.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$90.72

Cryo AHF

Facility

$504.00

Service Code	CPT P9044
Hospital Charge Code	1011948
Hospital Revenue Code	390
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$453.60
Rate for Payer: Aetna of AZ Commercial	$453.60
Rate for Payer: Bisbee Police All Plans	$131.04
Rate for Payer: Cash Price	$403.20
Rate for Payer: Self Pay Self Pay	$403.20

Cryoglobulin, Qualitative, Serum w/Quant Reflex LC

Facility

$82.00

Service Code	CPT 82595
Hospital Charge Code	12581373
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: AHCCCS Medicaid	$6.47
Rate for Payer: Allwell Medicaid	$6.47
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicaid	$6.47
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicaid	$6.47
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$53.30
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Mercy Care Medicaid	$6.47
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

Cryoglobulin, Qualitative, Serum w/Quant Reflex LC

Facility

$82.00

Service Code	CPT 82595
Hospital Charge Code	12581373
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

Cryo Pooled

Facility

$480.00

Service Code	CPT P9044
Hospital Charge Code	1221762
Hospital Revenue Code	390
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Bisbee Police All Plans	$124.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Self Pay Self Pay	$384.00

Cryo Pooled

Facility

$480.00

Service Code	CPT P9044
Hospital Charge Code	1221762
Hospital Revenue Code	390
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna of AZ Commercial	$432.00
Rate for Payer: Aetna of AZ Medicare	$134.40
Rate for Payer: AHCCCS Medicaid	$95.26
Rate for Payer: Allwell Medicaid	$95.26
Rate for Payer: Allwell Medicare	$72.00
Rate for Payer: Amerigroup Medicare	$72.00
Rate for Payer: APIPA Medicare/Medicaid	$179.28
Rate for Payer: AZCH Complete Medicaid	$95.26
Rate for Payer: AZCH Complete Medicare	$72.00
Rate for Payer: Banner UC Health Medicaid	$95.26
Rate for Payer: Banner UC Health Medicare	$72.00
Rate for Payer: Bisbee Police All Plans	$124.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$326.40
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cash Price	$384.00
Rate for Payer: Cigna of AZ Commercial	$312.00
Rate for Payer: Copperpoint Commercial	$118.80
Rate for Payer: Health Net of AZ Commercial	$288.00
Rate for Payer: Health Net of AZ Medicare	$134.40
Rate for Payer: Humana of AZ Medicare	$72.00
Rate for Payer: Mercy Care Medicaid	$95.26
Rate for Payer: Self Pay Self Pay	$384.00
Rate for Payer: TriWest Medicare	$72.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$279.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.40

Crystal, Synovial/Fluid LC

Facility

$708.00

Service Code	CPT 89060
Hospital Charge Code	3976233
Hospital Revenue Code	301
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Aetna of AZ Medicare	$198.24
Rate for Payer: AHCCCS Medicaid	$7.33
Rate for Payer: Allwell Medicaid	$7.33
Rate for Payer: Allwell Medicare	$106.20
Rate for Payer: Amerigroup Medicare	$106.20
Rate for Payer: APIPA Medicare/Medicaid	$264.44
Rate for Payer: AZCH Complete Medicaid	$7.33
Rate for Payer: AZCH Complete Medicare	$106.20
Rate for Payer: Banner UC Health Medicaid	$7.33
Rate for Payer: Banner UC Health Medicare	$106.20
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$481.44
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cash Price	$566.40
Rate for Payer: Cigna of AZ Commercial	$460.20
Rate for Payer: Copperpoint Commercial	$175.23
Rate for Payer: Health Net of AZ Commercial	$424.80
Rate for Payer: Health Net of AZ Medicare	$198.24
Rate for Payer: Humana of AZ Medicare	$106.20
Rate for Payer: Mercy Care Medicaid	$7.33
Rate for Payer: Self Pay Self Pay	$566.40
Rate for Payer: TriWest Medicare	$106.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$412.76
Rate for Payer: UnitedHealth Group of AZ Medicare	$127.44

Crystal, Synovial/Fluid LC

Facility

$708.00

Service Code	CPT 89060
Hospital Charge Code	3976233
Hospital Revenue Code	301
Min. Negotiated Rate	$184.08
Max. Negotiated Rate	$637.20
Rate for Payer: Aetna of AZ Commercial	$637.20
Rate for Payer: Bisbee Police All Plans	$184.08
Rate for Payer: Cash Price	$566.40
Rate for Payer: Self Pay Self Pay	$566.40

CSF Cell Count Standard

Facility

$120.00

Service Code	CPT 89051
Hospital Charge Code	22308749
Hospital Revenue Code	309
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

CSF Cell Count Standard

Facility

$120.00

Service Code	CPT 89051
Hospital Charge Code	22308749
Hospital Revenue Code	309
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: AHCCCS Medicaid	$5.60
Rate for Payer: Allwell Medicaid	$5.60
Rate for Payer: Allwell Medicare	$18.00
Rate for Payer: Amerigroup Medicare	$18.00
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicaid	$5.60
Rate for Payer: AZCH Complete Medicare	$18.00
Rate for Payer: Banner UC Health Medicaid	$5.60
Rate for Payer: Banner UC Health Medicare	$18.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$18.00
Rate for Payer: Mercy Care Medicaid	$5.60
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$18.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

CSF Culture

Facility

$122.00

Service Code	CPT 87070
Hospital Charge Code	858004
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of AZ Commercial	$109.80
Rate for Payer: Aetna of AZ Medicare	$34.16
Rate for Payer: AHCCCS Medicaid	$8.62
Rate for Payer: Allwell Medicaid	$8.62
Rate for Payer: Allwell Medicare	$18.30
Rate for Payer: Amerigroup Medicare	$18.30
Rate for Payer: APIPA Medicare/Medicaid	$45.57
Rate for Payer: AZCH Complete Medicaid	$8.62
Rate for Payer: AZCH Complete Medicare	$18.30
Rate for Payer: Banner UC Health Medicaid	$8.62
Rate for Payer: Banner UC Health Medicare	$18.30
Rate for Payer: Bisbee Police All Plans	$31.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$82.96
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cigna of AZ Commercial	$79.30
Rate for Payer: Copperpoint Commercial	$30.20
Rate for Payer: Health Net of AZ Commercial	$73.20
Rate for Payer: Health Net of AZ Medicare	$34.16
Rate for Payer: Humana of AZ Medicare	$18.30
Rate for Payer: Mercy Care Medicaid	$8.62
Rate for Payer: Self Pay Self Pay	$97.60
Rate for Payer: TriWest Medicare	$18.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$71.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.96

CSF Culture

Facility

$122.00

Service Code	CPT 87070
Hospital Charge Code	858004
Hospital Revenue Code	306
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna of AZ Commercial	$109.80
Rate for Payer: Bisbee Police All Plans	$31.72
Rate for Payer: Cash Price	$97.60
Rate for Payer: Self Pay Self Pay	$97.60

CT 3D Reconstruction

Facility

$1,166.00

Service Code	CPT 76377
Hospital Charge Code	1005104
Hospital Revenue Code	350
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Aetna of AZ Medicare	$326.48
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$174.90
Rate for Payer: Amerigroup Medicare	$174.90
Rate for Payer: APIPA Medicare/Medicaid	$435.50
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$174.90
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$174.90
Rate for Payer: Bisbee Police All Plans	$303.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$792.88
Rate for Payer: Cash Price	$932.80
Rate for Payer: Cash Price	$932.80
Rate for Payer: Cigna of AZ Commercial	$757.90
Rate for Payer: Copperpoint Commercial	$288.58
Rate for Payer: Health Net of AZ Commercial	$699.60
Rate for Payer: Health Net of AZ Medicare	$326.48
Rate for Payer: Humana of AZ Medicare	$174.90
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$932.80
Rate for Payer: TriWest Medicare	$174.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$679.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$209.88

CT 3D Reconstruction

Facility

$1,166.00

Service Code	CPT 76377
Hospital Charge Code	1005104
Hospital Revenue Code	350
Min. Negotiated Rate	$303.16
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Bisbee Police All Plans	$303.16
Rate for Payer: Cash Price	$932.80
Rate for Payer: Self Pay Self Pay	$932.80

CT Abdomen/Pelvis w/ Contrast

Facility

$4,410.00

Service Code	CPT 74177
Hospital Charge Code	1005109
Hospital Revenue Code	350
Min. Negotiated Rate	$1,146.60
Max. Negotiated Rate	$3,969.00
Rate for Payer: Aetna of AZ Commercial	$3,969.00
Rate for Payer: Bisbee Police All Plans	$1,146.60
Rate for Payer: Cash Price	$3,528.00
Rate for Payer: Self Pay Self Pay	$3,528.00

CT Abdomen/Pelvis w/ Contrast

Facility

$4,410.00

Service Code	CPT 74177
Hospital Charge Code	1005109
Hospital Revenue Code	350
Min. Negotiated Rate	$483.64
Max. Negotiated Rate	$3,969.00
Rate for Payer: Aetna of AZ Commercial	$3,969.00
Rate for Payer: Aetna of AZ Medicare	$1,234.80
Rate for Payer: AHCCCS Medicaid	$483.64
Rate for Payer: Allwell Medicaid	$483.64
Rate for Payer: Allwell Medicare	$661.50
Rate for Payer: Amerigroup Medicare	$661.50
Rate for Payer: APIPA Medicare/Medicaid	$1,647.14
Rate for Payer: AZCH Complete Medicaid	$483.64
Rate for Payer: AZCH Complete Medicare	$661.50
Rate for Payer: Banner UC Health Medicaid	$483.64
Rate for Payer: Banner UC Health Medicare	$661.50
Rate for Payer: Bisbee Police All Plans	$1,146.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,998.80
Rate for Payer: Cash Price	$3,528.00
Rate for Payer: Cash Price	$3,528.00
Rate for Payer: Cigna of AZ Commercial	$2,866.50
Rate for Payer: Copperpoint Commercial	$1,091.48
Rate for Payer: Health Net of AZ Commercial	$2,646.00
Rate for Payer: Health Net of AZ Medicare	$1,234.80
Rate for Payer: Humana of AZ Medicare	$661.50
Rate for Payer: Mercy Care Medicaid	$483.64
Rate for Payer: Self Pay Self Pay	$3,528.00
Rate for Payer: TriWest Medicare	$661.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,571.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$793.80

CT Abdomen/Pelvis w/o Contrast

Facility

$4,774.00

Service Code	CPT 74176
Hospital Charge Code	1005112
Hospital Revenue Code	350
Min. Negotiated Rate	$333.68
Max. Negotiated Rate	$4,296.60
Rate for Payer: Aetna of AZ Commercial	$4,296.60
Rate for Payer: Aetna of AZ Medicare	$1,336.72
Rate for Payer: AHCCCS Medicaid	$333.68
Rate for Payer: Allwell Medicaid	$333.68
Rate for Payer: Allwell Medicare	$716.10
Rate for Payer: Amerigroup Medicare	$716.10
Rate for Payer: APIPA Medicare/Medicaid	$1,783.09
Rate for Payer: AZCH Complete Medicaid	$333.68
Rate for Payer: AZCH Complete Medicare	$716.10
Rate for Payer: Banner UC Health Medicaid	$333.68
Rate for Payer: Banner UC Health Medicare	$716.10
Rate for Payer: Bisbee Police All Plans	$1,241.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,246.32
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Cigna of AZ Commercial	$3,103.10
Rate for Payer: Copperpoint Commercial	$1,181.56
Rate for Payer: Health Net of AZ Commercial	$2,864.40
Rate for Payer: Health Net of AZ Medicare	$1,336.72
Rate for Payer: Humana of AZ Medicare	$716.10
Rate for Payer: Mercy Care Medicaid	$333.68
Rate for Payer: Self Pay Self Pay	$3,819.20
Rate for Payer: TriWest Medicare	$716.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,783.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$859.32

CT Abdomen/Pelvis w/o Contrast

Facility

$4,774.00

Service Code	CPT 74176
Hospital Charge Code	1005112
Hospital Revenue Code	350
Min. Negotiated Rate	$1,241.24
Max. Negotiated Rate	$4,296.60
Rate for Payer: Aetna of AZ Commercial	$4,296.60
Rate for Payer: Bisbee Police All Plans	$1,241.24
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Self Pay Self Pay	$3,819.20

CT Abdomen/Pelvis w + w/o Contrast

Facility

$4,774.00

Service Code	CPT 74178
Hospital Charge Code	1005106
Hospital Revenue Code	350
Min. Negotiated Rate	$483.64
Max. Negotiated Rate	$4,296.60
Rate for Payer: Aetna of AZ Commercial	$4,296.60
Rate for Payer: Aetna of AZ Medicare	$1,336.72
Rate for Payer: AHCCCS Medicaid	$483.64
Rate for Payer: Allwell Medicaid	$483.64
Rate for Payer: Allwell Medicare	$716.10
Rate for Payer: Amerigroup Medicare	$716.10
Rate for Payer: APIPA Medicare/Medicaid	$1,783.09
Rate for Payer: AZCH Complete Medicaid	$483.64
Rate for Payer: AZCH Complete Medicare	$716.10
Rate for Payer: Banner UC Health Medicaid	$483.64
Rate for Payer: Banner UC Health Medicare	$716.10
Rate for Payer: Bisbee Police All Plans	$1,241.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,246.32
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Cigna of AZ Commercial	$3,103.10
Rate for Payer: Copperpoint Commercial	$1,181.56
Rate for Payer: Health Net of AZ Commercial	$2,864.40
Rate for Payer: Health Net of AZ Medicare	$1,336.72
Rate for Payer: Humana of AZ Medicare	$716.10
Rate for Payer: Mercy Care Medicaid	$483.64
Rate for Payer: Self Pay Self Pay	$3,819.20
Rate for Payer: TriWest Medicare	$716.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,783.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$859.32

CT Abdomen/Pelvis w + w/o Contrast

Facility

$4,774.00

Service Code	CPT 74178
Hospital Charge Code	1005106
Hospital Revenue Code	350
Min. Negotiated Rate	$1,241.24
Max. Negotiated Rate	$4,296.60
Rate for Payer: Aetna of AZ Commercial	$4,296.60
Rate for Payer: Bisbee Police All Plans	$1,241.24
Rate for Payer: Cash Price	$3,819.20
Rate for Payer: Self Pay Self Pay	$3,819.20

CT Abdomen w/ Contrast

Facility

$3,335.00

Service Code	CPT 74160
Hospital Charge Code	821328
Hospital Revenue Code	352
Min. Negotiated Rate	$867.10
Max. Negotiated Rate	$3,001.50
Rate for Payer: Aetna of AZ Commercial	$3,001.50
Rate for Payer: Bisbee Police All Plans	$867.10
Rate for Payer: Cash Price	$2,668.00
Rate for Payer: Self Pay Self Pay	$2,668.00

CT Abdomen w/ Contrast

Facility

$3,335.00

Service Code	CPT 74160
Hospital Charge Code	821328
Hospital Revenue Code	352
Min. Negotiated Rate	$258.90
Max. Negotiated Rate	$3,001.50
Rate for Payer: Aetna of AZ Commercial	$3,001.50
Rate for Payer: Aetna of AZ Medicare	$933.80
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$500.25
Rate for Payer: Amerigroup Medicare	$500.25
Rate for Payer: APIPA Medicare/Medicaid	$1,245.62
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$500.25
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$500.25
Rate for Payer: Bisbee Police All Plans	$867.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,267.80
Rate for Payer: Cash Price	$2,668.00
Rate for Payer: Cash Price	$2,668.00
Rate for Payer: Cigna of AZ Commercial	$2,167.75
Rate for Payer: Copperpoint Commercial	$825.41
Rate for Payer: Health Net of AZ Commercial	$2,001.00
Rate for Payer: Health Net of AZ Medicare	$933.80
Rate for Payer: Humana of AZ Medicare	$500.25
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$2,668.00
Rate for Payer: TriWest Medicare	$500.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,944.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$600.30

CT Abdomen w/o Contrast

Facility

$2,521.00

Service Code	CPT 74150
Hospital Charge Code	821330
Hospital Revenue Code	352
Min. Negotiated Rate	$655.46
Max. Negotiated Rate	$2,268.90
Rate for Payer: Aetna of AZ Commercial	$2,268.90
Rate for Payer: Bisbee Police All Plans	$655.46
Rate for Payer: Cash Price	$2,016.80
Rate for Payer: Self Pay Self Pay	$2,016.80

Know your out-of-pocket cost for care.

All Charges