Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CT Orbit Sella etc. w/o Contrast

Facility

$415.00

Service Code	CPT 70480
Hospital Charge Code	22862166
Hospital Revenue Code	972
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$373.50
Rate for Payer: Aetna of AZ Commercial	$373.50
Rate for Payer: Aetna of AZ Medicare	$116.20
Rate for Payer: Allwell Medicare	$66.40
Rate for Payer: Amerigroup Medicare	$66.40
Rate for Payer: APIPA Medicare/Medicaid	$155.00
Rate for Payer: AZCH Complete Medicare	$66.40
Rate for Payer: Banner UC Health Medicare	$66.40
Rate for Payer: Bisbee Police All Plans	$107.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$282.20
Rate for Payer: Cash Price	$332.00
Rate for Payer: Cigna of AZ Commercial	$290.50
Rate for Payer: Copperpoint Commercial	$102.71
Rate for Payer: Health Net of AZ Commercial	$249.00
Rate for Payer: Health Net of AZ Medicare	$116.20
Rate for Payer: Humana of AZ Medicare	$66.40
Rate for Payer: Self Pay Self Pay	$332.00
Rate for Payer: TriWest Medicare	$66.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$241.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$74.70

CT Orbit Sella etc. w/ + w/o Contrast

Facility

$3,197.00

Service Code	CPT 70482
Hospital Charge Code	1005187
Hospital Revenue Code	351
Min. Negotiated Rate	$831.22
Max. Negotiated Rate	$2,877.30
Rate for Payer: Aetna of AZ Commercial	$2,877.30
Rate for Payer: Bisbee Police All Plans	$831.22
Rate for Payer: Cash Price	$2,557.60
Rate for Payer: Self Pay Self Pay	$2,557.60

CT Orbit Sella etc. w/ + w/o Contrast

Facility

$544.00

Service Code	CPT 70482
Hospital Charge Code	22862168
Hospital Revenue Code	972
Min. Negotiated Rate	$87.04
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Aetna of AZ Medicare	$152.32
Rate for Payer: Allwell Medicare	$87.04
Rate for Payer: Amerigroup Medicare	$87.04
Rate for Payer: APIPA Medicare/Medicaid	$203.18
Rate for Payer: AZCH Complete Medicare	$87.04
Rate for Payer: Banner UC Health Medicare	$87.04
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$369.92
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cigna of AZ Commercial	$380.80
Rate for Payer: Copperpoint Commercial	$134.64
Rate for Payer: Health Net of AZ Commercial	$326.40
Rate for Payer: Health Net of AZ Medicare	$152.32
Rate for Payer: Humana of AZ Medicare	$87.04
Rate for Payer: Self Pay Self Pay	$435.20
Rate for Payer: TriWest Medicare	$87.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$317.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$97.92

CT Orbit Sella etc. w/ + w/o Contrast

Facility

$544.00

Service Code	CPT 70482
Hospital Charge Code	22862168
Hospital Revenue Code	972
Min. Negotiated Rate	$141.44
Max. Negotiated Rate	$489.60
Rate for Payer: Aetna of AZ Commercial	$489.60
Rate for Payer: Bisbee Police All Plans	$141.44
Rate for Payer: Cash Price	$435.20
Rate for Payer: Self Pay Self Pay	$435.20

CT Orbit Sella etc. w/ + w/o Contrast

Facility

$3,197.00

Service Code	CPT 70482
Hospital Charge Code	1005187
Hospital Revenue Code	351
Min. Negotiated Rate	$511.52
Max. Negotiated Rate	$2,877.30
Rate for Payer: Aetna of AZ Commercial	$2,877.30
Rate for Payer: Aetna of AZ Medicare	$895.16
Rate for Payer: Allwell Medicare	$511.52
Rate for Payer: Amerigroup Medicare	$511.52
Rate for Payer: APIPA Medicare/Medicaid	$1,194.08
Rate for Payer: AZCH Complete Medicare	$511.52
Rate for Payer: Banner UC Health Medicare	$511.52
Rate for Payer: Bisbee Police All Plans	$831.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,173.96
Rate for Payer: Cash Price	$2,557.60
Rate for Payer: Cigna of AZ Commercial	$2,078.05
Rate for Payer: Copperpoint Commercial	$791.26
Rate for Payer: Health Net of AZ Commercial	$1,918.20
Rate for Payer: Health Net of AZ Medicare	$895.16
Rate for Payer: Humana of AZ Medicare	$511.52
Rate for Payer: Self Pay Self Pay	$2,557.60
Rate for Payer: TriWest Medicare	$511.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,863.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$575.46

CT Pelvis w/ Contrast

Facility

$3,655.00

Service Code	CPT 72193
Hospital Charge Code	821359
Hospital Revenue Code	352
Min. Negotiated Rate	$950.30
Max. Negotiated Rate	$3,289.50
Rate for Payer: Aetna of AZ Commercial	$3,289.50
Rate for Payer: Bisbee Police All Plans	$950.30
Rate for Payer: Cash Price	$2,924.00
Rate for Payer: Self Pay Self Pay	$2,924.00

CT Pelvis w/ Contrast

Facility

$3,655.00

Service Code	CPT 72193
Hospital Charge Code	821359
Hospital Revenue Code	352
Min. Negotiated Rate	$584.80
Max. Negotiated Rate	$3,289.50
Rate for Payer: Aetna of AZ Commercial	$3,289.50
Rate for Payer: Aetna of AZ Medicare	$1,023.40
Rate for Payer: Allwell Medicare	$584.80
Rate for Payer: Amerigroup Medicare	$584.80
Rate for Payer: APIPA Medicare/Medicaid	$1,365.14
Rate for Payer: AZCH Complete Medicare	$584.80
Rate for Payer: Banner UC Health Medicare	$584.80
Rate for Payer: Bisbee Police All Plans	$950.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,485.40
Rate for Payer: Cash Price	$2,924.00
Rate for Payer: Cigna of AZ Commercial	$2,375.75
Rate for Payer: Copperpoint Commercial	$904.61
Rate for Payer: Health Net of AZ Commercial	$2,193.00
Rate for Payer: Health Net of AZ Medicare	$1,023.40
Rate for Payer: Humana of AZ Medicare	$584.80
Rate for Payer: Self Pay Self Pay	$2,924.00
Rate for Payer: TriWest Medicare	$584.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,130.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$657.90

CT Pelvis w/o Contrast

Facility

$1,953.00

Service Code	CPT 72192
Hospital Charge Code	821361
Hospital Revenue Code	352
Min. Negotiated Rate	$312.48
Max. Negotiated Rate	$1,757.70
Rate for Payer: Aetna of AZ Commercial	$1,757.70
Rate for Payer: Aetna of AZ Medicare	$546.84
Rate for Payer: Allwell Medicare	$312.48
Rate for Payer: Amerigroup Medicare	$312.48
Rate for Payer: APIPA Medicare/Medicaid	$729.45
Rate for Payer: AZCH Complete Medicare	$312.48
Rate for Payer: Banner UC Health Medicare	$312.48
Rate for Payer: Bisbee Police All Plans	$507.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,328.04
Rate for Payer: Cash Price	$1,562.40
Rate for Payer: Cigna of AZ Commercial	$1,269.45
Rate for Payer: Copperpoint Commercial	$483.37
Rate for Payer: Health Net of AZ Commercial	$1,171.80
Rate for Payer: Health Net of AZ Medicare	$546.84
Rate for Payer: Humana of AZ Medicare	$312.48
Rate for Payer: Self Pay Self Pay	$1,562.40
Rate for Payer: TriWest Medicare	$312.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,138.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$351.54

CT Pelvis w/o Contrast

Facility

$1,953.00

Service Code	CPT 72192
Hospital Charge Code	821361
Hospital Revenue Code	352
Min. Negotiated Rate	$507.78
Max. Negotiated Rate	$1,757.70
Rate for Payer: Aetna of AZ Commercial	$1,757.70
Rate for Payer: Bisbee Police All Plans	$507.78
Rate for Payer: Cash Price	$1,562.40
Rate for Payer: Self Pay Self Pay	$1,562.40

CT Pelvis w/ + w/o Contrast

Facility

$2,619.00

Service Code	CPT 72194
Hospital Charge Code	821357
Hospital Revenue Code	352
Min. Negotiated Rate	$419.04
Max. Negotiated Rate	$2,357.10
Rate for Payer: Aetna of AZ Commercial	$2,357.10
Rate for Payer: Aetna of AZ Medicare	$733.32
Rate for Payer: Allwell Medicare	$419.04
Rate for Payer: Amerigroup Medicare	$419.04
Rate for Payer: APIPA Medicare/Medicaid	$978.20
Rate for Payer: AZCH Complete Medicare	$419.04
Rate for Payer: Banner UC Health Medicare	$419.04
Rate for Payer: Bisbee Police All Plans	$680.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,780.92
Rate for Payer: Cash Price	$2,095.20
Rate for Payer: Cigna of AZ Commercial	$1,702.35
Rate for Payer: Copperpoint Commercial	$648.20
Rate for Payer: Health Net of AZ Commercial	$1,571.40
Rate for Payer: Health Net of AZ Medicare	$733.32
Rate for Payer: Humana of AZ Medicare	$419.04
Rate for Payer: Self Pay Self Pay	$2,095.20
Rate for Payer: TriWest Medicare	$419.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,526.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$471.42

CT Pelvis w/ + w/o Contrast

Facility

$2,619.00

Service Code	CPT 72194
Hospital Charge Code	821357
Hospital Revenue Code	352
Min. Negotiated Rate	$680.94
Max. Negotiated Rate	$2,357.10
Rate for Payer: Aetna of AZ Commercial	$2,357.10
Rate for Payer: Bisbee Police All Plans	$680.94
Rate for Payer: Cash Price	$2,095.20
Rate for Payer: Self Pay Self Pay	$2,095.20

CT Soft Tissue Neck w/ Contrast

Facility

$2,678.00

Service Code	CPT 70491
Hospital Charge Code	821368
Hospital Revenue Code	351
Min. Negotiated Rate	$696.28
Max. Negotiated Rate	$2,410.20
Rate for Payer: Aetna of AZ Commercial	$2,410.20
Rate for Payer: Bisbee Police All Plans	$696.28
Rate for Payer: Cash Price	$2,142.40
Rate for Payer: Self Pay Self Pay	$2,142.40

CT Soft Tissue Neck w/ Contrast

Facility

$2,678.00

Service Code	CPT 70491
Hospital Charge Code	821368
Hospital Revenue Code	351
Min. Negotiated Rate	$428.48
Max. Negotiated Rate	$2,410.20
Rate for Payer: Aetna of AZ Commercial	$2,410.20
Rate for Payer: Aetna of AZ Medicare	$749.84
Rate for Payer: Allwell Medicare	$428.48
Rate for Payer: Amerigroup Medicare	$428.48
Rate for Payer: APIPA Medicare/Medicaid	$1,000.23
Rate for Payer: AZCH Complete Medicare	$428.48
Rate for Payer: Banner UC Health Medicare	$428.48
Rate for Payer: Bisbee Police All Plans	$696.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,821.04
Rate for Payer: Cash Price	$2,142.40
Rate for Payer: Cigna of AZ Commercial	$1,740.70
Rate for Payer: Copperpoint Commercial	$662.80
Rate for Payer: Health Net of AZ Commercial	$1,606.80
Rate for Payer: Health Net of AZ Medicare	$749.84
Rate for Payer: Humana of AZ Medicare	$428.48
Rate for Payer: Self Pay Self Pay	$2,142.40
Rate for Payer: TriWest Medicare	$428.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,561.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$482.04

CT Soft Tissue Neck w/o Contrast

Facility

$2,352.00

Service Code	CPT 70490
Hospital Charge Code	821370
Hospital Revenue Code	351
Min. Negotiated Rate	$376.32
Max. Negotiated Rate	$2,116.80
Rate for Payer: Aetna of AZ Commercial	$2,116.80
Rate for Payer: Aetna of AZ Medicare	$658.56
Rate for Payer: Allwell Medicare	$376.32
Rate for Payer: Amerigroup Medicare	$376.32
Rate for Payer: APIPA Medicare/Medicaid	$878.47
Rate for Payer: AZCH Complete Medicare	$376.32
Rate for Payer: Banner UC Health Medicare	$376.32
Rate for Payer: Bisbee Police All Plans	$611.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,599.36
Rate for Payer: Cash Price	$1,881.60
Rate for Payer: Cigna of AZ Commercial	$1,528.80
Rate for Payer: Copperpoint Commercial	$582.12
Rate for Payer: Health Net of AZ Commercial	$1,411.20
Rate for Payer: Health Net of AZ Medicare	$658.56
Rate for Payer: Humana of AZ Medicare	$376.32
Rate for Payer: Self Pay Self Pay	$1,881.60
Rate for Payer: TriWest Medicare	$376.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,371.22
Rate for Payer: UnitedHealth Group of AZ Medicare	$423.36

CT Soft Tissue Neck w/o Contrast

Facility

$2,352.00

Service Code	CPT 70490
Hospital Charge Code	821370
Hospital Revenue Code	351
Min. Negotiated Rate	$611.52
Max. Negotiated Rate	$2,116.80
Rate for Payer: Aetna of AZ Commercial	$2,116.80
Rate for Payer: Bisbee Police All Plans	$611.52
Rate for Payer: Cash Price	$1,881.60
Rate for Payer: Self Pay Self Pay	$1,881.60

CT Soft Tissue Neck w/ + w/o Contrast

Facility

$3,382.00

Service Code	CPT 70492
Hospital Charge Code	821366
Hospital Revenue Code	351
Min. Negotiated Rate	$541.12
Max. Negotiated Rate	$3,043.80
Rate for Payer: Aetna of AZ Commercial	$3,043.80
Rate for Payer: Aetna of AZ Medicare	$946.96
Rate for Payer: Allwell Medicare	$541.12
Rate for Payer: Amerigroup Medicare	$541.12
Rate for Payer: APIPA Medicare/Medicaid	$1,263.18
Rate for Payer: AZCH Complete Medicare	$541.12
Rate for Payer: Banner UC Health Medicare	$541.12
Rate for Payer: Bisbee Police All Plans	$879.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,299.76
Rate for Payer: Cash Price	$2,705.60
Rate for Payer: Cigna of AZ Commercial	$2,198.30
Rate for Payer: Copperpoint Commercial	$837.04
Rate for Payer: Health Net of AZ Commercial	$2,029.20
Rate for Payer: Health Net of AZ Medicare	$946.96
Rate for Payer: Humana of AZ Medicare	$541.12
Rate for Payer: Self Pay Self Pay	$2,705.60
Rate for Payer: TriWest Medicare	$541.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,971.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$608.76

CT Soft Tissue Neck w/ + w/o Contrast

Facility

$3,382.00

Service Code	CPT 70492
Hospital Charge Code	821366
Hospital Revenue Code	351
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$3,043.80
Rate for Payer: Aetna of AZ Commercial	$3,043.80
Rate for Payer: Bisbee Police All Plans	$879.32
Rate for Payer: Cash Price	$2,705.60
Rate for Payer: Self Pay Self Pay	$2,705.60

CT Spine Cervical w/ Contrast

Facility

$2,579.00

Service Code	CPT 72126
Hospital Charge Code	1005215
Hospital Revenue Code	352
Min. Negotiated Rate	$412.64
Max. Negotiated Rate	$2,321.10
Rate for Payer: Aetna of AZ Commercial	$2,321.10
Rate for Payer: Aetna of AZ Medicare	$722.12
Rate for Payer: Allwell Medicare	$412.64
Rate for Payer: Amerigroup Medicare	$412.64
Rate for Payer: APIPA Medicare/Medicaid	$963.26
Rate for Payer: AZCH Complete Medicare	$412.64
Rate for Payer: Banner UC Health Medicare	$412.64
Rate for Payer: Bisbee Police All Plans	$670.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,753.72
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Cigna of AZ Commercial	$1,676.35
Rate for Payer: Copperpoint Commercial	$638.30
Rate for Payer: Health Net of AZ Commercial	$1,547.40
Rate for Payer: Health Net of AZ Medicare	$722.12
Rate for Payer: Humana of AZ Medicare	$412.64
Rate for Payer: Self Pay Self Pay	$2,063.20
Rate for Payer: TriWest Medicare	$412.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,503.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$464.22

CT Spine Cervical w/ Contrast

Facility

$2,579.00

Service Code	CPT 72126
Hospital Charge Code	1005215
Hospital Revenue Code	352
Min. Negotiated Rate	$670.54
Max. Negotiated Rate	$2,321.10
Rate for Payer: Aetna of AZ Commercial	$2,321.10
Rate for Payer: Bisbee Police All Plans	$670.54
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Self Pay Self Pay	$2,063.20

CT Spine Cervical w/o Contrast

Facility

$2,949.00

Service Code	CPT 72125
Hospital Charge Code	821372
Hospital Revenue Code	352
Min. Negotiated Rate	$766.74
Max. Negotiated Rate	$2,654.10
Rate for Payer: Aetna of AZ Commercial	$2,654.10
Rate for Payer: Bisbee Police All Plans	$766.74
Rate for Payer: Cash Price	$2,359.20
Rate for Payer: Self Pay Self Pay	$2,359.20

CT Spine Cervical w/o Contrast

Facility

$2,949.00

Service Code	CPT 72125
Hospital Charge Code	821372
Hospital Revenue Code	352
Min. Negotiated Rate	$471.84
Max. Negotiated Rate	$2,654.10
Rate for Payer: Aetna of AZ Commercial	$2,654.10
Rate for Payer: Aetna of AZ Medicare	$825.72
Rate for Payer: Allwell Medicare	$471.84
Rate for Payer: Amerigroup Medicare	$471.84
Rate for Payer: APIPA Medicare/Medicaid	$1,101.45
Rate for Payer: AZCH Complete Medicare	$471.84
Rate for Payer: Banner UC Health Medicare	$471.84
Rate for Payer: Bisbee Police All Plans	$766.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,005.32
Rate for Payer: Cash Price	$2,359.20
Rate for Payer: Cigna of AZ Commercial	$1,916.85
Rate for Payer: Copperpoint Commercial	$729.88
Rate for Payer: Health Net of AZ Commercial	$1,769.40
Rate for Payer: Health Net of AZ Medicare	$825.72
Rate for Payer: Humana of AZ Medicare	$471.84
Rate for Payer: Self Pay Self Pay	$2,359.20
Rate for Payer: TriWest Medicare	$471.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,719.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$530.82

CT Spine Cervical w/ + w/o Contrast

Facility

$1,643.00

Service Code	CPT 72127
Hospital Charge Code	1005213
Hospital Revenue Code	352
Min. Negotiated Rate	$262.88
Max. Negotiated Rate	$1,478.70
Rate for Payer: Aetna of AZ Commercial	$1,478.70
Rate for Payer: Aetna of AZ Medicare	$460.04
Rate for Payer: Allwell Medicare	$262.88
Rate for Payer: Amerigroup Medicare	$262.88
Rate for Payer: APIPA Medicare/Medicaid	$613.66
Rate for Payer: AZCH Complete Medicare	$262.88
Rate for Payer: Banner UC Health Medicare	$262.88
Rate for Payer: Bisbee Police All Plans	$427.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,117.24
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Cigna of AZ Commercial	$1,067.95
Rate for Payer: Copperpoint Commercial	$406.64
Rate for Payer: Health Net of AZ Commercial	$985.80
Rate for Payer: Health Net of AZ Medicare	$460.04
Rate for Payer: Humana of AZ Medicare	$262.88
Rate for Payer: Self Pay Self Pay	$1,314.40
Rate for Payer: TriWest Medicare	$262.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$957.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$295.74

CT Spine Cervical w/ + w/o Contrast

Facility

$1,643.00

Service Code	CPT 72127
Hospital Charge Code	1005213
Hospital Revenue Code	352
Min. Negotiated Rate	$427.18
Max. Negotiated Rate	$1,478.70
Rate for Payer: Aetna of AZ Commercial	$1,478.70
Rate for Payer: Bisbee Police All Plans	$427.18
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Self Pay Self Pay	$1,314.40

CT Spine Lumbar w/ Contrast

Facility

$3,131.00

Service Code	CPT 72132
Hospital Charge Code	1005219
Hospital Revenue Code	352
Min. Negotiated Rate	$500.96
Max. Negotiated Rate	$2,817.90
Rate for Payer: Aetna of AZ Commercial	$2,817.90
Rate for Payer: Aetna of AZ Medicare	$876.68
Rate for Payer: Allwell Medicare	$500.96
Rate for Payer: Amerigroup Medicare	$500.96
Rate for Payer: APIPA Medicare/Medicaid	$1,169.43
Rate for Payer: AZCH Complete Medicare	$500.96
Rate for Payer: Banner UC Health Medicare	$500.96
Rate for Payer: Bisbee Police All Plans	$814.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,129.08
Rate for Payer: Cash Price	$2,504.80
Rate for Payer: Cigna of AZ Commercial	$2,035.15
Rate for Payer: Copperpoint Commercial	$774.92
Rate for Payer: Health Net of AZ Commercial	$1,878.60
Rate for Payer: Health Net of AZ Medicare	$876.68
Rate for Payer: Humana of AZ Medicare	$500.96
Rate for Payer: Self Pay Self Pay	$2,504.80
Rate for Payer: TriWest Medicare	$500.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,825.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$563.58

CT Spine Lumbar w/ Contrast

Facility

$3,131.00

Service Code	CPT 72132
Hospital Charge Code	1005219
Hospital Revenue Code	352
Min. Negotiated Rate	$814.06
Max. Negotiated Rate	$2,817.90
Rate for Payer: Aetna of AZ Commercial	$2,817.90
Rate for Payer: Bisbee Police All Plans	$814.06
Rate for Payer: Cash Price	$2,504.80
Rate for Payer: Self Pay Self Pay	$2,504.80

Know your out-of-pocket cost for care.

All Charges