Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CT Head or Brain w/ Contrast

Facility

$2,207.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$258.90
Max. Negotiated Rate	$1,986.30
Rate for Payer: Aetna of AZ Commercial	$1,986.30
Rate for Payer: Aetna of AZ Medicare	$617.96
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$331.05
Rate for Payer: Amerigroup Medicare	$331.05
Rate for Payer: APIPA Medicare/Medicaid	$824.31
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$331.05
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$331.05
Rate for Payer: Bisbee Police All Plans	$573.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,500.76
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Cigna of AZ Commercial	$1,434.55
Rate for Payer: Copperpoint Commercial	$546.23
Rate for Payer: Health Net of AZ Commercial	$1,324.20
Rate for Payer: Health Net of AZ Medicare	$617.96
Rate for Payer: Humana of AZ Medicare	$331.05
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$1,765.60
Rate for Payer: TriWest Medicare	$331.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,286.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$397.26

CT Head or Brain w/ Contrast

Facility

$2,207.00

Service Code	CPT 70460
Hospital Charge Code	821334
Hospital Revenue Code	351
Min. Negotiated Rate	$573.82
Max. Negotiated Rate	$1,986.30
Rate for Payer: Aetna of AZ Commercial	$1,986.30
Rate for Payer: Bisbee Police All Plans	$573.82
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Self Pay Self Pay	$1,765.60

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Aetna of AZ Medicare	$107.24
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$57.45
Rate for Payer: Amerigroup Medicare	$57.45
Rate for Payer: APIPA Medicare/Medicaid	$143.05
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$57.45
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$57.45
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$260.44
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cigna of AZ Commercial	$268.10
Rate for Payer: Copperpoint Commercial	$94.79
Rate for Payer: Health Net of AZ Commercial	$229.80
Rate for Payer: Health Net of AZ Medicare	$107.24
Rate for Payer: Humana of AZ Medicare	$57.45
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$306.40
Rate for Payer: TriWest Medicare	$57.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$223.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.94

CT Head or Brain w/ Contrast

Facility

$383.00

Service Code	CPT 70460
Hospital Charge Code	22862164
Hospital Revenue Code	972
Min. Negotiated Rate	$99.58
Max. Negotiated Rate	$344.70
Rate for Payer: Aetna of AZ Commercial	$344.70
Rate for Payer: Bisbee Police All Plans	$99.58
Rate for Payer: Cash Price	$306.40
Rate for Payer: Self Pay Self Pay	$306.40

CT Head or Brain w/o Contrast

Facility

$1,747.00

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$1,572.30
Rate for Payer: Aetna of AZ Commercial	$1,572.30
Rate for Payer: Aetna of AZ Medicare	$489.16
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$262.05
Rate for Payer: Amerigroup Medicare	$262.05
Rate for Payer: APIPA Medicare/Medicaid	$652.50
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$262.05
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$262.05
Rate for Payer: Bisbee Police All Plans	$454.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,187.96
Rate for Payer: Cash Price	$1,397.60
Rate for Payer: Cash Price	$1,397.60
Rate for Payer: Cigna of AZ Commercial	$1,135.55
Rate for Payer: Copperpoint Commercial	$432.38
Rate for Payer: Health Net of AZ Commercial	$1,048.20
Rate for Payer: Health Net of AZ Medicare	$489.16
Rate for Payer: Humana of AZ Medicare	$262.05
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$1,397.60
Rate for Payer: TriWest Medicare	$262.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,018.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$314.46

CT Head or Brain w/o Contrast

Facility

$1,747.00

Service Code	CPT 70450
Hospital Charge Code	821336
Hospital Revenue Code	351
Min. Negotiated Rate	$454.22
Max. Negotiated Rate	$1,572.30
Rate for Payer: Aetna of AZ Commercial	$1,572.30
Rate for Payer: Bisbee Police All Plans	$454.22
Rate for Payer: Cash Price	$1,397.60
Rate for Payer: Self Pay Self Pay	$1,397.60

CT Head or Brain w/ + w/o Contrast

Facility

$2,709.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$704.34
Max. Negotiated Rate	$2,438.10
Rate for Payer: Aetna of AZ Commercial	$2,438.10
Rate for Payer: Bisbee Police All Plans	$704.34
Rate for Payer: Cash Price	$2,167.20
Rate for Payer: Self Pay Self Pay	$2,167.20

CT Head or Brain w/ + w/o Contrast

Facility

$2,709.00

Service Code	CPT 70470
Hospital Charge Code	821332
Hospital Revenue Code	351
Min. Negotiated Rate	$258.90
Max. Negotiated Rate	$2,438.10
Rate for Payer: Aetna of AZ Commercial	$2,438.10
Rate for Payer: Aetna of AZ Medicare	$758.52
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$406.35
Rate for Payer: Amerigroup Medicare	$406.35
Rate for Payer: APIPA Medicare/Medicaid	$1,011.81
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$406.35
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$406.35
Rate for Payer: Bisbee Police All Plans	$704.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,842.12
Rate for Payer: Cash Price	$2,167.20
Rate for Payer: Cash Price	$2,167.20
Rate for Payer: Cigna of AZ Commercial	$1,760.85
Rate for Payer: Copperpoint Commercial	$670.48
Rate for Payer: Health Net of AZ Commercial	$1,625.40
Rate for Payer: Health Net of AZ Medicare	$758.52
Rate for Payer: Humana of AZ Medicare	$406.35
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$2,167.20
Rate for Payer: TriWest Medicare	$406.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,579.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$487.62

CT Lower Extremity w/ Contrast Left

Facility

$2,389.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$621.14
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Self Pay Self Pay	$1,911.20

CT Lower Extremity w/ Contrast Left

Facility

$2,389.00

Service Code	CPT 73701 LT
Hospital Charge Code	821338
Hospital Revenue Code	352
Min. Negotiated Rate	$358.35
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Aetna of AZ Medicare	$668.92
Rate for Payer: Allwell Medicare	$358.35
Rate for Payer: Amerigroup Medicare	$358.35
Rate for Payer: APIPA Medicare/Medicaid	$892.29
Rate for Payer: AZCH Complete Medicare	$358.35
Rate for Payer: Banner UC Health Medicare	$358.35
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,624.52
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Cigna of AZ Commercial	$1,552.85
Rate for Payer: Copperpoint Commercial	$591.28
Rate for Payer: Health Net of AZ Commercial	$1,433.40
Rate for Payer: Health Net of AZ Medicare	$668.92
Rate for Payer: Humana of AZ Medicare	$358.35
Rate for Payer: Self Pay Self Pay	$1,911.20
Rate for Payer: TriWest Medicare	$358.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,392.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$430.02

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$621.14
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Self Pay Self Pay	$1,911.20

CT Lower Extremity w/ Contrast Right

Facility

$2,389.00

Service Code	CPT 73701 RT
Hospital Charge Code	821340
Hospital Revenue Code	352
Min. Negotiated Rate	$358.35
Max. Negotiated Rate	$2,150.10
Rate for Payer: Aetna of AZ Commercial	$2,150.10
Rate for Payer: Aetna of AZ Medicare	$668.92
Rate for Payer: Allwell Medicare	$358.35
Rate for Payer: Amerigroup Medicare	$358.35
Rate for Payer: APIPA Medicare/Medicaid	$892.29
Rate for Payer: AZCH Complete Medicare	$358.35
Rate for Payer: Banner UC Health Medicare	$358.35
Rate for Payer: Bisbee Police All Plans	$621.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,624.52
Rate for Payer: Cash Price	$1,911.20
Rate for Payer: Cigna of AZ Commercial	$1,552.85
Rate for Payer: Copperpoint Commercial	$591.28
Rate for Payer: Health Net of AZ Commercial	$1,433.40
Rate for Payer: Health Net of AZ Medicare	$668.92
Rate for Payer: Humana of AZ Medicare	$358.35
Rate for Payer: Self Pay Self Pay	$1,911.20
Rate for Payer: TriWest Medicare	$358.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,392.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$430.02

CT Lower Extremity w/o Contrast Left

Facility

$2,019.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$524.94
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Bisbee Police All Plans	$524.94
Rate for Payer: Cash Price	$1,615.20
Rate for Payer: Self Pay Self Pay	$1,615.20

CT Lower Extremity w/o Contrast Left

Facility

$2,019.00

Service Code	CPT 73700 LT
Hospital Charge Code	821342
Hospital Revenue Code	352
Min. Negotiated Rate	$302.85
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Aetna of AZ Medicare	$565.32
Rate for Payer: Allwell Medicare	$302.85
Rate for Payer: Amerigroup Medicare	$302.85
Rate for Payer: APIPA Medicare/Medicaid	$754.10
Rate for Payer: AZCH Complete Medicare	$302.85
Rate for Payer: Banner UC Health Medicare	$302.85
Rate for Payer: Bisbee Police All Plans	$524.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,372.92
Rate for Payer: Cash Price	$1,615.20
Rate for Payer: Cigna of AZ Commercial	$1,312.35
Rate for Payer: Copperpoint Commercial	$499.70
Rate for Payer: Health Net of AZ Commercial	$1,211.40
Rate for Payer: Health Net of AZ Medicare	$565.32
Rate for Payer: Humana of AZ Medicare	$302.85
Rate for Payer: Self Pay Self Pay	$1,615.20
Rate for Payer: TriWest Medicare	$302.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,177.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$363.42

CT Lower Extremity w/o Contrast Right

Facility

$2,019.00

Service Code	CPT 73700 RT
Hospital Charge Code	821344
Hospital Revenue Code	352
Min. Negotiated Rate	$524.94
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Bisbee Police All Plans	$524.94
Rate for Payer: Cash Price	$1,615.20
Rate for Payer: Self Pay Self Pay	$1,615.20

CT Lower Extremity w/o Contrast Right

Facility

$2,019.00

Service Code	CPT 73700 RT
Hospital Charge Code	821344
Hospital Revenue Code	352
Min. Negotiated Rate	$302.85
Max. Negotiated Rate	$1,817.10
Rate for Payer: Aetna of AZ Commercial	$1,817.10
Rate for Payer: Aetna of AZ Medicare	$565.32
Rate for Payer: Allwell Medicare	$302.85
Rate for Payer: Amerigroup Medicare	$302.85
Rate for Payer: APIPA Medicare/Medicaid	$754.10
Rate for Payer: AZCH Complete Medicare	$302.85
Rate for Payer: Banner UC Health Medicare	$302.85
Rate for Payer: Bisbee Police All Plans	$524.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,372.92
Rate for Payer: Cash Price	$1,615.20
Rate for Payer: Cigna of AZ Commercial	$1,312.35
Rate for Payer: Copperpoint Commercial	$499.70
Rate for Payer: Health Net of AZ Commercial	$1,211.40
Rate for Payer: Health Net of AZ Medicare	$565.32
Rate for Payer: Humana of AZ Medicare	$302.85
Rate for Payer: Self Pay Self Pay	$1,615.20
Rate for Payer: TriWest Medicare	$302.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,177.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$363.42

CT Lower Extremity w/ + w/o Contrast Left

Facility

$2,521.00

Service Code	CPT 73702 LT
Hospital Charge Code	1101576
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

CT Lower Extremity w/ + w/o Contrast Left

Facility

$2,521.00

Service Code	CPT 73702 LT
Hospital Charge Code	1101576
Hospital Revenue Code	352
Min. Negotiated Rate	$378.15
Max. Negotiated Rate	$2,268.90
Rate for Payer: Aetna of AZ Commercial	$2,268.90
Rate for Payer: Aetna of AZ Medicare	$705.88
Rate for Payer: Allwell Medicare	$378.15
Rate for Payer: Amerigroup Medicare	$378.15
Rate for Payer: APIPA Medicare/Medicaid	$941.59
Rate for Payer: AZCH Complete Medicare	$378.15
Rate for Payer: Banner UC Health Medicare	$378.15
Rate for Payer: Bisbee Police All Plans	$655.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,714.28
Rate for Payer: Cash Price	$2,016.80
Rate for Payer: Cigna of AZ Commercial	$1,638.65
Rate for Payer: Copperpoint Commercial	$623.95
Rate for Payer: Health Net of AZ Commercial	$1,512.60
Rate for Payer: Health Net of AZ Medicare	$705.88
Rate for Payer: Humana of AZ Medicare	$378.15
Rate for Payer: Self Pay Self Pay	$2,016.80
Rate for Payer: TriWest Medicare	$378.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,469.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$453.78

CT Lower Extremity w/+w/o Contrast Left

Facility

$2,521.00

Service Code	CPT 73702
Hospital Charge Code	1005179
Hospital Revenue Code	352
Min. Negotiated Rate	$258.90
Max. Negotiated Rate	$2,268.90
Rate for Payer: Aetna of AZ Commercial	$2,268.90
Rate for Payer: Aetna of AZ Medicare	$705.88
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$378.15
Rate for Payer: Amerigroup Medicare	$378.15
Rate for Payer: APIPA Medicare/Medicaid	$941.59
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$378.15
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$378.15
Rate for Payer: Bisbee Police All Plans	$655.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,714.28
Rate for Payer: Cash Price	$2,016.80
Rate for Payer: Cash Price	$2,016.80
Rate for Payer: Cigna of AZ Commercial	$1,638.65
Rate for Payer: Copperpoint Commercial	$623.95
Rate for Payer: Health Net of AZ Commercial	$1,512.60
Rate for Payer: Health Net of AZ Medicare	$705.88
Rate for Payer: Humana of AZ Medicare	$378.15
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$2,016.80
Rate for Payer: TriWest Medicare	$378.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,469.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$453.78

CT Lower Extremity w/+w/o Contrast Left

Facility

$2,521.00

Service Code	CPT 73702
Hospital Charge Code	1005179
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

CT Lower Extremity w/ + w/o Contrast Right

Facility

$2,521.00

Service Code	CPT 73702 RT
Hospital Charge Code	1101579
Hospital Revenue Code	352
Min. Negotiated Rate	$378.15
Max. Negotiated Rate	$2,268.90
Rate for Payer: Aetna of AZ Commercial	$2,268.90
Rate for Payer: Aetna of AZ Medicare	$705.88
Rate for Payer: Allwell Medicare	$378.15
Rate for Payer: Amerigroup Medicare	$378.15
Rate for Payer: APIPA Medicare/Medicaid	$941.59
Rate for Payer: AZCH Complete Medicare	$378.15
Rate for Payer: Banner UC Health Medicare	$378.15
Rate for Payer: Bisbee Police All Plans	$655.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,714.28
Rate for Payer: Cash Price	$2,016.80
Rate for Payer: Cigna of AZ Commercial	$1,638.65
Rate for Payer: Copperpoint Commercial	$623.95
Rate for Payer: Health Net of AZ Commercial	$1,512.60
Rate for Payer: Health Net of AZ Medicare	$705.88
Rate for Payer: Humana of AZ Medicare	$378.15
Rate for Payer: Self Pay Self Pay	$2,016.80
Rate for Payer: TriWest Medicare	$378.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,469.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$453.78

CT Lower Extremity w/ + w/o Contrast Right

Facility

$2,521.00

Service Code	CPT 73702 RT
Hospital Charge Code	1101579
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

CT Lower Extremity w/+w/o Contrast Right

Facility

$3,039.00

Service Code	CPT 73702
Hospital Charge Code	1005181
Hospital Revenue Code	352
Min. Negotiated Rate	$258.90
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Aetna of AZ Medicare	$850.92
Rate for Payer: AHCCCS Medicaid	$258.90
Rate for Payer: Allwell Medicaid	$258.90
Rate for Payer: Allwell Medicare	$455.85
Rate for Payer: Amerigroup Medicare	$455.85
Rate for Payer: APIPA Medicare/Medicaid	$1,135.07
Rate for Payer: AZCH Complete Medicaid	$258.90
Rate for Payer: AZCH Complete Medicare	$455.85
Rate for Payer: Banner UC Health Medicaid	$258.90
Rate for Payer: Banner UC Health Medicare	$455.85
Rate for Payer: Bisbee Police All Plans	$790.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,066.52
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Cigna of AZ Commercial	$1,975.35
Rate for Payer: Copperpoint Commercial	$752.15
Rate for Payer: Health Net of AZ Commercial	$1,823.40
Rate for Payer: Health Net of AZ Medicare	$850.92
Rate for Payer: Humana of AZ Medicare	$455.85
Rate for Payer: Mercy Care Medicaid	$258.90
Rate for Payer: Self Pay Self Pay	$2,431.20
Rate for Payer: TriWest Medicare	$455.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,771.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$547.02

CT Lower Extremity w/+w/o Contrast Right

Facility

$3,039.00

Service Code	CPT 73702
Hospital Charge Code	1005181
Hospital Revenue Code	352
Min. Negotiated Rate	$790.14
Max. Negotiated Rate	$2,735.10
Rate for Payer: Aetna of AZ Commercial	$2,735.10
Rate for Payer: Bisbee Police All Plans	$790.14
Rate for Payer: Cash Price	$2,431.20
Rate for Payer: Self Pay Self Pay	$2,431.20

CT Maxillofacial w/ Contrast

Facility

$2,470.00

Service Code	CPT 70487
Hospital Charge Code	821346
Hospital Revenue Code	351
Min. Negotiated Rate	$642.20
Max. Negotiated Rate	$2,223.00
Rate for Payer: Aetna of AZ Commercial	$2,223.00
Rate for Payer: Bisbee Police All Plans	$642.20
Rate for Payer: Cash Price	$1,976.00
Rate for Payer: Self Pay Self Pay	$1,976.00

Know your out-of-pocket cost for care.

All Charges