Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGEAL VARICIES BANDING

Facility

$6,347.00

Service Code	CPT 43244
Hospital Charge Code	23598982
Hospital Revenue Code	750
Min. Negotiated Rate	$1,650.22
Max. Negotiated Rate	$5,712.30
Rate for Payer: Aetna of AZ Commercial	$5,712.30
Rate for Payer: Bisbee Police All Plans	$1,650.22
Rate for Payer: Cash Price	$5,077.60
Rate for Payer: Self Pay Self Pay	$5,077.60

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$493.48
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Self Pay Self Pay	$1,518.40

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACH

Facility

$1,898.00

Service Code	CPT 91035
Hospital Charge Code	23598979
Hospital Revenue Code	750
Min. Negotiated Rate	$284.70
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Aetna of AZ Medicare	$531.44
Rate for Payer: AHCCCS Medicaid	$707.28
Rate for Payer: Allwell Medicaid	$707.28
Rate for Payer: Allwell Medicare	$284.70
Rate for Payer: Amerigroup Medicare	$284.70
Rate for Payer: APIPA Medicare/Medicaid	$708.90
Rate for Payer: AZCH Complete Medicaid	$707.28
Rate for Payer: AZCH Complete Medicare	$284.70
Rate for Payer: Banner UC Health Medicaid	$707.28
Rate for Payer: Banner UC Health Medicare	$284.70
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,290.64
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Copperpoint Commercial	$469.76
Rate for Payer: Health Net of AZ Commercial	$1,138.80
Rate for Payer: Health Net of AZ Medicare	$531.44
Rate for Payer: Humana of AZ Medicare	$284.70
Rate for Payer: Mercy Care Medicaid	$707.28
Rate for Payer: Self Pay Self Pay	$1,518.40
Rate for Payer: TriWest Medicare	$284.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,106.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$341.64

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$284.70
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Aetna of AZ Medicare	$531.44
Rate for Payer: AHCCCS Medicaid	$707.28
Rate for Payer: Allwell Medicaid	$707.28
Rate for Payer: Allwell Medicare	$284.70
Rate for Payer: Amerigroup Medicare	$284.70
Rate for Payer: APIPA Medicare/Medicaid	$708.90
Rate for Payer: AZCH Complete Medicaid	$707.28
Rate for Payer: AZCH Complete Medicare	$284.70
Rate for Payer: Banner UC Health Medicaid	$707.28
Rate for Payer: Banner UC Health Medicare	$284.70
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,290.64
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cigna of AZ Commercial	$1,328.60
Rate for Payer: Copperpoint Commercial	$469.76
Rate for Payer: Health Net of AZ Commercial	$1,138.80
Rate for Payer: Health Net of AZ Medicare	$531.44
Rate for Payer: Humana of AZ Medicare	$284.70
Rate for Payer: Mercy Care Medicaid	$707.28
Rate for Payer: Self Pay Self Pay	$1,518.40
Rate for Payer: TriWest Medicare	$284.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,106.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$341.64

ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER

Facility

$1,898.00

Service Code	CPT 91034
Hospital Charge Code	23598977
Hospital Revenue Code	750
Min. Negotiated Rate	$493.48
Max. Negotiated Rate	$1,708.20
Rate for Payer: Aetna of AZ Commercial	$1,708.20
Rate for Payer: Bisbee Police All Plans	$493.48
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Self Pay Self Pay	$1,518.40

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$379.05
Max. Negotiated Rate	$6,393.84
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Aetna of AZ Medicare	$707.56
Rate for Payer: AHCCCS Medicaid	$6,393.84
Rate for Payer: Allwell Medicaid	$6,393.84
Rate for Payer: Allwell Medicare	$379.05
Rate for Payer: Amerigroup Medicare	$379.05
Rate for Payer: APIPA Medicare/Medicaid	$943.83
Rate for Payer: AZCH Complete Medicaid	$6,393.84
Rate for Payer: AZCH Complete Medicare	$379.05
Rate for Payer: Banner UC Health Medicaid	$6,393.84
Rate for Payer: Banner UC Health Medicare	$379.05
Rate for Payer: Bisbee Police All Plans	$657.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,718.36
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cigna of AZ Commercial	$1,768.90
Rate for Payer: Copperpoint Commercial	$625.43
Rate for Payer: Health Net of AZ Commercial	$1,516.20
Rate for Payer: Health Net of AZ Medicare	$707.56
Rate for Payer: Humana of AZ Medicare	$379.05
Rate for Payer: Mercy Care Medicaid	$6,393.84
Rate for Payer: Self Pay Self Pay	$2,021.60
Rate for Payer: TriWest Medicare	$379.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,540.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$454.86

ESSURE PERMANENT BIRTH CONTROL SYSTEM

Facility

$2,527.00

Service Code	CPT 58565
Hospital Charge Code	22354170
Hospital Revenue Code	270
Min. Negotiated Rate	$657.02
Max. Negotiated Rate	$2,274.30
Rate for Payer: Aetna of AZ Commercial	$2,274.30
Rate for Payer: Bisbee Police All Plans	$657.02
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Self Pay Self Pay	$2,021.60

Estradiol LC

Facility

$348.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Aetna of AZ Medicare	$97.44
Rate for Payer: AHCCCS Medicaid	$27.94
Rate for Payer: Allwell Medicaid	$27.94
Rate for Payer: Allwell Medicare	$52.20
Rate for Payer: Amerigroup Medicare	$52.20
Rate for Payer: APIPA Medicare/Medicaid	$129.98
Rate for Payer: AZCH Complete Medicaid	$27.94
Rate for Payer: AZCH Complete Medicare	$52.20
Rate for Payer: Banner UC Health Medicaid	$27.94
Rate for Payer: Banner UC Health Medicare	$52.20
Rate for Payer: Bisbee Police All Plans	$90.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$236.64
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cigna of AZ Commercial	$226.20
Rate for Payer: Copperpoint Commercial	$86.13
Rate for Payer: Health Net of AZ Commercial	$208.80
Rate for Payer: Health Net of AZ Medicare	$97.44
Rate for Payer: Humana of AZ Medicare	$52.20
Rate for Payer: Mercy Care Medicaid	$27.94
Rate for Payer: Self Pay Self Pay	$278.40
Rate for Payer: TriWest Medicare	$52.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$202.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.64

Estradiol LC

Facility

$348.00

Service Code	CPT 82670
Hospital Charge Code	1285575
Hospital Revenue Code	301
Min. Negotiated Rate	$90.48
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Bisbee Police All Plans	$90.48
Rate for Payer: Cash Price	$278.40
Rate for Payer: Self Pay Self Pay	$278.40

Estradiol, Sensitive, LC

Facility

$348.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$90.48
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Bisbee Police All Plans	$90.48
Rate for Payer: Cash Price	$278.40
Rate for Payer: Self Pay Self Pay	$278.40

Estradiol, Sensitive, LC

Facility

$348.00

Service Code	CPT 82670
Hospital Charge Code	19106382
Hospital Revenue Code	301
Min. Negotiated Rate	$27.94
Max. Negotiated Rate	$313.20
Rate for Payer: Aetna of AZ Commercial	$313.20
Rate for Payer: Aetna of AZ Medicare	$97.44
Rate for Payer: AHCCCS Medicaid	$27.94
Rate for Payer: Allwell Medicaid	$27.94
Rate for Payer: Allwell Medicare	$52.20
Rate for Payer: Amerigroup Medicare	$52.20
Rate for Payer: APIPA Medicare/Medicaid	$129.98
Rate for Payer: AZCH Complete Medicaid	$27.94
Rate for Payer: AZCH Complete Medicare	$52.20
Rate for Payer: Banner UC Health Medicaid	$27.94
Rate for Payer: Banner UC Health Medicare	$52.20
Rate for Payer: Bisbee Police All Plans	$90.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$236.64
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cigna of AZ Commercial	$226.20
Rate for Payer: Copperpoint Commercial	$86.13
Rate for Payer: Health Net of AZ Commercial	$208.80
Rate for Payer: Health Net of AZ Medicare	$97.44
Rate for Payer: Humana of AZ Medicare	$52.20
Rate for Payer: Mercy Care Medicaid	$27.94
Rate for Payer: Self Pay Self Pay	$278.40
Rate for Payer: TriWest Medicare	$52.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$202.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$62.64

Estriol, Serum LC

Facility

$344.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$89.44
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of AZ Commercial	$309.60
Rate for Payer: Bisbee Police All Plans	$89.44
Rate for Payer: Cash Price	$275.20
Rate for Payer: Self Pay Self Pay	$275.20

Estriol, Serum LC

Facility

$344.00

Service Code	CPT 82677
Hospital Charge Code	22200848
Hospital Revenue Code	301
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$309.60
Rate for Payer: Aetna of AZ Commercial	$309.60
Rate for Payer: Aetna of AZ Medicare	$96.32
Rate for Payer: AHCCCS Medicaid	$24.18
Rate for Payer: Allwell Medicaid	$24.18
Rate for Payer: Allwell Medicare	$51.60
Rate for Payer: Amerigroup Medicare	$51.60
Rate for Payer: APIPA Medicare/Medicaid	$128.48
Rate for Payer: AZCH Complete Medicaid	$24.18
Rate for Payer: AZCH Complete Medicare	$51.60
Rate for Payer: Banner UC Health Medicaid	$24.18
Rate for Payer: Banner UC Health Medicare	$51.60
Rate for Payer: Bisbee Police All Plans	$89.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$233.92
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cigna of AZ Commercial	$223.60
Rate for Payer: Copperpoint Commercial	$85.14
Rate for Payer: Health Net of AZ Commercial	$206.40
Rate for Payer: Health Net of AZ Medicare	$96.32
Rate for Payer: Humana of AZ Medicare	$51.60
Rate for Payer: Mercy Care Medicaid	$24.18
Rate for Payer: Self Pay Self Pay	$275.20
Rate for Payer: TriWest Medicare	$51.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$200.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.92

Estrogens, Total LC

Facility

$271.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$70.46
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Bisbee Police All Plans	$70.46
Rate for Payer: Cash Price	$216.80
Rate for Payer: Self Pay Self Pay	$216.80

Estrogens, Total LC

Facility

$271.00

Service Code	CPT 82672
Hospital Charge Code	1906843
Hospital Revenue Code	301
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$243.90
Rate for Payer: Aetna of AZ Commercial	$243.90
Rate for Payer: Aetna of AZ Medicare	$75.88
Rate for Payer: AHCCCS Medicaid	$21.70
Rate for Payer: Allwell Medicaid	$21.70
Rate for Payer: Allwell Medicare	$40.65
Rate for Payer: Amerigroup Medicare	$40.65
Rate for Payer: APIPA Medicare/Medicaid	$101.22
Rate for Payer: AZCH Complete Medicaid	$21.70
Rate for Payer: AZCH Complete Medicare	$40.65
Rate for Payer: Banner UC Health Medicaid	$21.70
Rate for Payer: Banner UC Health Medicare	$40.65
Rate for Payer: Bisbee Police All Plans	$70.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$184.28
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cigna of AZ Commercial	$176.15
Rate for Payer: Copperpoint Commercial	$67.07
Rate for Payer: Health Net of AZ Commercial	$162.60
Rate for Payer: Health Net of AZ Medicare	$75.88
Rate for Payer: Humana of AZ Medicare	$40.65
Rate for Payer: Mercy Care Medicaid	$21.70
Rate for Payer: Self Pay Self Pay	$216.80
Rate for Payer: TriWest Medicare	$40.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$157.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.78

Estrone LC

Facility

$310.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Aetna of AZ Medicare	$86.80
Rate for Payer: AHCCCS Medicaid	$24.95
Rate for Payer: Allwell Medicaid	$24.95
Rate for Payer: Allwell Medicare	$46.50
Rate for Payer: Amerigroup Medicare	$46.50
Rate for Payer: APIPA Medicare/Medicaid	$115.78
Rate for Payer: AZCH Complete Medicaid	$24.95
Rate for Payer: AZCH Complete Medicare	$46.50
Rate for Payer: Banner UC Health Medicaid	$24.95
Rate for Payer: Banner UC Health Medicare	$46.50
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$210.80
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cigna of AZ Commercial	$201.50
Rate for Payer: Copperpoint Commercial	$76.72
Rate for Payer: Health Net of AZ Commercial	$186.00
Rate for Payer: Health Net of AZ Medicare	$86.80
Rate for Payer: Humana of AZ Medicare	$46.50
Rate for Payer: Mercy Care Medicaid	$24.95
Rate for Payer: Self Pay Self Pay	$248.00
Rate for Payer: TriWest Medicare	$46.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$180.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.80

Estrone LC

Facility

$310.00

Service Code	CPT 82679
Hospital Charge Code	6738646
Hospital Revenue Code	301
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna of AZ Commercial	$279.00
Rate for Payer: Bisbee Police All Plans	$80.60
Rate for Payer: Cash Price	$248.00
Rate for Payer: Self Pay Self Pay	$248.00

Ethanol, Urine LC

Facility

$139.00

Service Code	CPT G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Aetna of AZ Medicare	$38.92
Rate for Payer: Allwell Medicare	$20.85
Rate for Payer: Amerigroup Medicare	$20.85
Rate for Payer: APIPA Medicare/Medicaid	$51.92
Rate for Payer: AZCH Complete Medicare	$20.85
Rate for Payer: Banner UC Health Medicare	$20.85
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$94.52
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$90.35
Rate for Payer: Copperpoint Commercial	$34.40
Rate for Payer: Health Net of AZ Commercial	$83.40
Rate for Payer: Health Net of AZ Medicare	$38.92
Rate for Payer: Humana of AZ Medicare	$20.85
Rate for Payer: Self Pay Self Pay	$111.20
Rate for Payer: TriWest Medicare	$20.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$81.04
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.02

Ethanol, Urine LC

Facility

$139.00

Service Code	CPT G6040
Hospital Charge Code	22201906
Hospital Revenue Code	306
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Bisbee Police All Plans	$36.14
Rate for Payer: Cash Price	$111.20
Rate for Payer: Self Pay Self Pay	$111.20

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Cash Price	$0.21
Rate for Payer: Self Pay Self Pay	$0.21

ethyl chloride Topical spray-medium stream [CQCH]

Facility

$0.26

Service Code	NDC 386000111
Hospital Charge Code	105921705
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of AZ Commercial	$0.23
Rate for Payer: Aetna of AZ Medicare	$0.07
Rate for Payer: Allwell Medicare	$0.04
Rate for Payer: Amerigroup Medicare	$0.04
Rate for Payer: APIPA Medicare/Medicaid	$0.10
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.18
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of AZ Commercial	$0.17
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.16
Rate for Payer: Health Net of AZ Medicare	$0.07
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Self Pay Self Pay	$0.21
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.05

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Bisbee Police All Plans	$1.25
Rate for Payer: Cash Price	$3.84
Rate for Payer: Self Pay Self Pay	$3.84

etomidate 20 mg Inj Sol [CQCH]

Facility

$4.80

Service Code	NDC 72266014610
Hospital Charge Code	105921770
Hospital Revenue Code	251
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna of AZ Commercial	$4.32
Rate for Payer: Aetna of AZ Medicare	$1.34
Rate for Payer: Allwell Medicare	$0.72
Rate for Payer: Amerigroup Medicare	$0.72
Rate for Payer: APIPA Medicare/Medicaid	$1.79
Rate for Payer: AZCH Complete Medicare	$0.72
Rate for Payer: Banner UC Health Medicare	$0.72
Rate for Payer: Bisbee Police All Plans	$1.25
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.26
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cigna of AZ Commercial	$3.12
Rate for Payer: Copperpoint Commercial	$1.19
Rate for Payer: Health Net of AZ Commercial	$2.88
Rate for Payer: Health Net of AZ Medicare	$1.34
Rate for Payer: Humana of AZ Medicare	$0.72
Rate for Payer: Self Pay Self Pay	$3.84
Rate for Payer: TriWest Medicare	$0.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.86

EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH

Facility

$1,791.00

Service Code	CPT 28080
Hospital Charge Code	24043265
Hospital Revenue Code	360
Min. Negotiated Rate	$268.65
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,611.90
Rate for Payer: Aetna of AZ Medicare	$501.48
Rate for Payer: AHCCCS Medicaid	$2,018.90
Rate for Payer: Allwell Medicaid	$2,018.90
Rate for Payer: Allwell Medicare	$268.65
Rate for Payer: Amerigroup Medicare	$268.65
Rate for Payer: APIPA Medicare/Medicaid	$668.94
Rate for Payer: AZCH Complete Medicaid	$2,018.90
Rate for Payer: AZCH Complete Medicare	$268.65
Rate for Payer: Banner UC Health Medicaid	$2,018.90
Rate for Payer: Banner UC Health Medicare	$268.65
Rate for Payer: Bisbee Police All Plans	$465.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,217.88
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cigna of AZ Commercial	$895.50
Rate for Payer: Copperpoint Commercial	$443.27
Rate for Payer: Health Net of AZ Commercial	$1,074.60
Rate for Payer: Health Net of AZ Medicare	$501.48
Rate for Payer: Humana of AZ Medicare	$268.65
Rate for Payer: Mercy Care Medicaid	$2,018.90
Rate for Payer: Self Pay Self Pay	$1,432.80
Rate for Payer: TriWest Medicare	$268.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$322.38

EXCISION INTERDIGITAL (MORTON) NEUROMA SINGLE EACH

Facility

$1,791.00

Service Code	CPT 28080
Hospital Charge Code	24043265
Hospital Revenue Code	360
Min. Negotiated Rate	$465.66
Max. Negotiated Rate	$1,611.90
Rate for Payer: Aetna of AZ Commercial	$1,611.90
Rate for Payer: Bisbee Police All Plans	$465.66
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Self Pay Self Pay	$1,432.80

Know your out-of-pocket cost for care.

All Charges