Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

27786 CLSD TX FX DIS FIB WO/MA

Facility

$1,076.00

Service Code	CPT 27786
Hospital Charge Code	22282867
Hospital Revenue Code	450
Min. Negotiated Rate	$279.76
Max. Negotiated Rate	$968.40
Rate for Payer: Aetna of AZ Commercial	$968.40
Rate for Payer: Bisbee Police All Plans	$279.76
Rate for Payer: Cash Price	$860.80
Rate for Payer: Self Pay Self Pay	$860.80

27788 CLSD TX FX DISTFIB W/M

Facility

$1,544.00

Service Code	CPT 27788
Hospital Charge Code	22282868
Hospital Revenue Code	450
Min. Negotiated Rate	$401.44
Max. Negotiated Rate	$1,389.60
Rate for Payer: Aetna of AZ Commercial	$1,389.60
Rate for Payer: Bisbee Police All Plans	$401.44
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Self Pay Self Pay	$1,235.20

27788 CLSD TX FX DISTFIB W/M

Facility

$1,544.00

Service Code	CPT 27788
Hospital Charge Code	22282868
Hospital Revenue Code	450
Min. Negotiated Rate	$231.60
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,389.60
Rate for Payer: Aetna of AZ Medicare	$432.32
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$231.60
Rate for Payer: Amerigroup Medicare	$231.60
Rate for Payer: APIPA Medicare/Medicaid	$576.68
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$231.60
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$231.60
Rate for Payer: Bisbee Police All Plans	$401.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,049.92
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Cigna of AZ Commercial	$1,080.80
Rate for Payer: Copperpoint Commercial	$382.14
Rate for Payer: Health Net of AZ Commercial	$926.40
Rate for Payer: Health Net of AZ Medicare	$432.32
Rate for Payer: Humana of AZ Medicare	$231.60
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$1,235.20
Rate for Payer: TriWest Medicare	$231.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$277.92

27808 CLD TX FX BIMALL AKL WOM

Facility

$1,288.00

Service Code	CPT 27808
Hospital Charge Code	22282869
Hospital Revenue Code	450
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,159.20
Rate for Payer: Aetna of AZ Medicare	$360.64
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$193.20
Rate for Payer: Amerigroup Medicare	$193.20
Rate for Payer: APIPA Medicare/Medicaid	$481.07
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$193.20
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$193.20
Rate for Payer: Bisbee Police All Plans	$334.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$875.84
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Cigna of AZ Commercial	$901.60
Rate for Payer: Copperpoint Commercial	$318.78
Rate for Payer: Health Net of AZ Commercial	$772.80
Rate for Payer: Health Net of AZ Medicare	$360.64
Rate for Payer: Humana of AZ Medicare	$193.20
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$1,030.40
Rate for Payer: TriWest Medicare	$193.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$231.84

27808 CLD TX FX BIMALL AKL WOM

Facility

$1,288.00

Service Code	CPT 27808
Hospital Charge Code	22282869
Hospital Revenue Code	450
Min. Negotiated Rate	$334.88
Max. Negotiated Rate	$1,159.20
Rate for Payer: Aetna of AZ Commercial	$1,159.20
Rate for Payer: Bisbee Police All Plans	$334.88
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Self Pay Self Pay	$1,030.40

27810 CLSD TXFXBIMALL ANKLN/MN

Facility

$2,134.00

Service Code	CPT 27810
Hospital Charge Code	22282870
Hospital Revenue Code	450
Min. Negotiated Rate	$554.84
Max. Negotiated Rate	$1,920.60
Rate for Payer: Aetna of AZ Commercial	$1,920.60
Rate for Payer: Bisbee Police All Plans	$554.84
Rate for Payer: Cash Price	$1,707.20
Rate for Payer: Self Pay Self Pay	$1,707.20

27810 CLSD TXFXBIMALL ANKLN/MN

Facility

$2,134.00

Service Code	CPT 27810
Hospital Charge Code	22282870
Hospital Revenue Code	450
Min. Negotiated Rate	$320.10
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$1,920.60
Rate for Payer: Aetna of AZ Medicare	$597.52
Rate for Payer: AHCCCS Medicaid	$2,018.90
Rate for Payer: Allwell Medicaid	$2,018.90
Rate for Payer: Allwell Medicare	$320.10
Rate for Payer: Amerigroup Medicare	$320.10
Rate for Payer: APIPA Medicare/Medicaid	$797.05
Rate for Payer: AZCH Complete Medicaid	$2,018.90
Rate for Payer: AZCH Complete Medicare	$320.10
Rate for Payer: Banner UC Health Medicaid	$2,018.90
Rate for Payer: Banner UC Health Medicare	$320.10
Rate for Payer: Bisbee Police All Plans	$554.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,451.12
Rate for Payer: Cash Price	$1,707.20
Rate for Payer: Cash Price	$1,707.20
Rate for Payer: Cigna of AZ Commercial	$1,493.80
Rate for Payer: Copperpoint Commercial	$528.16
Rate for Payer: Health Net of AZ Commercial	$1,280.40
Rate for Payer: Health Net of AZ Medicare	$597.52
Rate for Payer: Humana of AZ Medicare	$320.10
Rate for Payer: Mercy Care Medicaid	$2,018.90
Rate for Payer: Self Pay Self Pay	$1,707.20
Rate for Payer: TriWest Medicare	$320.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$384.12

27840 CLSD TX AKLE DIS W/O ANE

Facility

$1,675.00

Service Code	CPT 27840
Hospital Charge Code	22282871
Hospital Revenue Code	450
Min. Negotiated Rate	$251.25
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,507.50
Rate for Payer: Aetna of AZ Medicare	$469.00
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$251.25
Rate for Payer: Amerigroup Medicare	$251.25
Rate for Payer: APIPA Medicare/Medicaid	$625.61
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$251.25
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$251.25
Rate for Payer: Bisbee Police All Plans	$435.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,139.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Cigna of AZ Commercial	$1,172.50
Rate for Payer: Copperpoint Commercial	$414.56
Rate for Payer: Health Net of AZ Commercial	$1,005.00
Rate for Payer: Health Net of AZ Medicare	$469.00
Rate for Payer: Humana of AZ Medicare	$251.25
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$1,340.00
Rate for Payer: TriWest Medicare	$251.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$301.50

27840 CLSD TX AKLE DIS W/O ANE

Facility

$1,675.00

Service Code	CPT 27840
Hospital Charge Code	22282871
Hospital Revenue Code	450
Min. Negotiated Rate	$435.50
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna of AZ Commercial	$1,507.50
Rate for Payer: Bisbee Police All Plans	$435.50
Rate for Payer: Cash Price	$1,340.00
Rate for Payer: Self Pay Self Pay	$1,340.00

28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH

Facility

$1,549.00

Service Code	CPT 28108
Hospital Charge Code	27410736
Hospital Revenue Code	360
Min. Negotiated Rate	$232.35
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Aetna of AZ Medicare	$433.72
Rate for Payer: AHCCCS Medicaid	$2,018.90
Rate for Payer: Allwell Medicaid	$2,018.90
Rate for Payer: Allwell Medicare	$232.35
Rate for Payer: Amerigroup Medicare	$232.35
Rate for Payer: APIPA Medicare/Medicaid	$578.55
Rate for Payer: AZCH Complete Medicaid	$2,018.90
Rate for Payer: AZCH Complete Medicare	$232.35
Rate for Payer: Banner UC Health Medicaid	$2,018.90
Rate for Payer: Banner UC Health Medicare	$232.35
Rate for Payer: Bisbee Police All Plans	$402.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,053.32
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cigna of AZ Commercial	$774.50
Rate for Payer: Copperpoint Commercial	$383.38
Rate for Payer: Health Net of AZ Commercial	$929.40
Rate for Payer: Health Net of AZ Medicare	$433.72
Rate for Payer: Humana of AZ Medicare	$232.35
Rate for Payer: Mercy Care Medicaid	$2,018.90
Rate for Payer: Self Pay Self Pay	$1,239.20
Rate for Payer: TriWest Medicare	$232.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$278.82

28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PH

Facility

$1,549.00

Service Code	CPT 28108
Hospital Charge Code	27410736
Hospital Revenue Code	360
Min. Negotiated Rate	$402.74
Max. Negotiated Rate	$1,394.10
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Bisbee Police All Plans	$402.74
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Self Pay Self Pay	$1,239.20

28490 CLSD TX FX GR TOE W/O MA

Facility

$457.00

Service Code	CPT 28490
Hospital Charge Code	22282872
Hospital Revenue Code	450
Min. Negotiated Rate	$118.82
Max. Negotiated Rate	$411.30
Rate for Payer: Aetna of AZ Commercial	$411.30
Rate for Payer: Bisbee Police All Plans	$118.82
Rate for Payer: Cash Price	$365.60
Rate for Payer: Self Pay Self Pay	$365.60

28490 CLSD TX FX GR TOE W/O MA

Facility

$457.00

Service Code	CPT 28490
Hospital Charge Code	22282872
Hospital Revenue Code	450
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$411.30
Rate for Payer: Aetna of AZ Medicare	$127.96
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$68.55
Rate for Payer: Amerigroup Medicare	$68.55
Rate for Payer: APIPA Medicare/Medicaid	$170.69
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$68.55
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$68.55
Rate for Payer: Bisbee Police All Plans	$118.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$310.76
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cigna of AZ Commercial	$319.90
Rate for Payer: Copperpoint Commercial	$113.11
Rate for Payer: Health Net of AZ Commercial	$274.20
Rate for Payer: Health Net of AZ Medicare	$127.96
Rate for Payer: Humana of AZ Medicare	$68.55
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$365.60
Rate for Payer: TriWest Medicare	$68.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$82.26

28495 CLSD TX FX GR TOE W/MANI

Facility

$580.00

Service Code	CPT 28495
Hospital Charge Code	22282873
Hospital Revenue Code	450
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$522.00
Rate for Payer: Aetna of AZ Medicare	$162.40
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$87.00
Rate for Payer: Amerigroup Medicare	$87.00
Rate for Payer: APIPA Medicare/Medicaid	$216.63
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$87.00
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$87.00
Rate for Payer: Bisbee Police All Plans	$150.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$394.40
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cigna of AZ Commercial	$406.00
Rate for Payer: Copperpoint Commercial	$143.55
Rate for Payer: Health Net of AZ Commercial	$348.00
Rate for Payer: Health Net of AZ Medicare	$162.40
Rate for Payer: Humana of AZ Medicare	$87.00
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$464.00
Rate for Payer: TriWest Medicare	$87.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.40

28495 CLSD TX FX GR TOE W/MANI

Facility

$580.00

Service Code	CPT 28495
Hospital Charge Code	22282873
Hospital Revenue Code	450
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$522.00
Rate for Payer: Aetna of AZ Commercial	$522.00
Rate for Payer: Bisbee Police All Plans	$150.80
Rate for Payer: Cash Price	$464.00
Rate for Payer: Self Pay Self Pay	$464.00

28660 REDUCTION DISLOCATED TOE

Facility

$397.00

Service Code	CPT 28660
Hospital Charge Code	22282874
Hospital Revenue Code	450
Min. Negotiated Rate	$103.22
Max. Negotiated Rate	$357.30
Rate for Payer: Aetna of AZ Commercial	$357.30
Rate for Payer: Bisbee Police All Plans	$103.22
Rate for Payer: Cash Price	$317.60
Rate for Payer: Self Pay Self Pay	$317.60

28660 REDUCTION DISLOCATED TOE

Facility

$397.00

Service Code	CPT 28660
Hospital Charge Code	22282874
Hospital Revenue Code	450
Min. Negotiated Rate	$59.55
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$357.30
Rate for Payer: Aetna of AZ Medicare	$111.16
Rate for Payer: AHCCCS Medicaid	$298.98
Rate for Payer: Allwell Medicaid	$298.98
Rate for Payer: Allwell Medicare	$59.55
Rate for Payer: Amerigroup Medicare	$59.55
Rate for Payer: APIPA Medicare/Medicaid	$148.28
Rate for Payer: AZCH Complete Medicaid	$298.98
Rate for Payer: AZCH Complete Medicare	$59.55
Rate for Payer: Banner UC Health Medicaid	$298.98
Rate for Payer: Banner UC Health Medicare	$59.55
Rate for Payer: Bisbee Police All Plans	$103.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$269.96
Rate for Payer: Cash Price	$317.60
Rate for Payer: Cash Price	$317.60
Rate for Payer: Cigna of AZ Commercial	$277.90
Rate for Payer: Copperpoint Commercial	$98.26
Rate for Payer: Health Net of AZ Commercial	$238.20
Rate for Payer: Health Net of AZ Medicare	$111.16
Rate for Payer: Humana of AZ Medicare	$59.55
Rate for Payer: Mercy Care Medicaid	$298.98
Rate for Payer: Self Pay Self Pay	$317.60
Rate for Payer: TriWest Medicare	$59.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.46

29105 APL LNG ARM SPLNT

Facility

$201.00

Service Code	CPT 29105
Hospital Charge Code	22282875
Hospital Revenue Code	450
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$180.90
Rate for Payer: Aetna of AZ Medicare	$56.28
Rate for Payer: AHCCCS Medicaid	$204.72
Rate for Payer: Allwell Medicaid	$204.72
Rate for Payer: Allwell Medicare	$30.15
Rate for Payer: Amerigroup Medicare	$30.15
Rate for Payer: APIPA Medicare/Medicaid	$75.07
Rate for Payer: AZCH Complete Medicaid	$204.72
Rate for Payer: AZCH Complete Medicare	$30.15
Rate for Payer: Banner UC Health Medicaid	$204.72
Rate for Payer: Banner UC Health Medicare	$30.15
Rate for Payer: Bisbee Police All Plans	$52.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$136.68
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cigna of AZ Commercial	$140.70
Rate for Payer: Copperpoint Commercial	$49.75
Rate for Payer: Health Net of AZ Commercial	$120.60
Rate for Payer: Health Net of AZ Medicare	$56.28
Rate for Payer: Humana of AZ Medicare	$30.15
Rate for Payer: Mercy Care Medicaid	$204.72
Rate for Payer: Self Pay Self Pay	$160.80
Rate for Payer: TriWest Medicare	$30.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.18

29105 APL LNG ARM SPLNT

Facility

$201.00

Service Code	CPT 29105
Hospital Charge Code	22282875
Hospital Revenue Code	450
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$180.90
Rate for Payer: Aetna of AZ Commercial	$180.90
Rate for Payer: Bisbee Police All Plans	$52.26
Rate for Payer: Cash Price	$160.80
Rate for Payer: Self Pay Self Pay	$160.80

29125 APL SPLINT SHORT ARM

Facility

$225.00

Service Code	CPT 29125
Hospital Charge Code	22282876
Hospital Revenue Code	450
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Aetna of AZ Medicare	$63.00
Rate for Payer: AHCCCS Medicaid	$162.32
Rate for Payer: Allwell Medicaid	$162.32
Rate for Payer: Allwell Medicare	$33.75
Rate for Payer: Amerigroup Medicare	$33.75
Rate for Payer: APIPA Medicare/Medicaid	$84.04
Rate for Payer: AZCH Complete Medicaid	$162.32
Rate for Payer: AZCH Complete Medicare	$33.75
Rate for Payer: Banner UC Health Medicaid	$162.32
Rate for Payer: Banner UC Health Medicare	$33.75
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$153.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of AZ Commercial	$157.50
Rate for Payer: Copperpoint Commercial	$55.69
Rate for Payer: Health Net of AZ Commercial	$135.00
Rate for Payer: Health Net of AZ Medicare	$63.00
Rate for Payer: Humana of AZ Medicare	$33.75
Rate for Payer: Mercy Care Medicaid	$162.32
Rate for Payer: Self Pay Self Pay	$180.00
Rate for Payer: TriWest Medicare	$33.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.50

29125 APL SPLINT SHORT ARM

Facility

$225.00

Service Code	CPT 29125
Hospital Charge Code	22282876
Hospital Revenue Code	450
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna of AZ Commercial	$202.50
Rate for Payer: Bisbee Police All Plans	$58.50
Rate for Payer: Cash Price	$180.00
Rate for Payer: Self Pay Self Pay	$180.00

29130 APL FNG SPLNT STATIC

Facility

$147.00

Service Code	CPT 29130
Hospital Charge Code	22282877
Hospital Revenue Code	450
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Cash Price	$117.60
Rate for Payer: Self Pay Self Pay	$117.60

29130 APL FNG SPLNT STATIC

Facility

$147.00

Service Code	CPT 29130
Hospital Charge Code	22282877
Hospital Revenue Code	450
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$132.30
Rate for Payer: Aetna of AZ Medicare	$41.16
Rate for Payer: AHCCCS Medicaid	$162.32
Rate for Payer: Allwell Medicaid	$162.32
Rate for Payer: Allwell Medicare	$22.05
Rate for Payer: Amerigroup Medicare	$22.05
Rate for Payer: APIPA Medicare/Medicaid	$54.90
Rate for Payer: AZCH Complete Medicaid	$162.32
Rate for Payer: AZCH Complete Medicare	$22.05
Rate for Payer: Banner UC Health Medicaid	$162.32
Rate for Payer: Banner UC Health Medicare	$22.05
Rate for Payer: Bisbee Police All Plans	$38.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$99.96
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cigna of AZ Commercial	$102.90
Rate for Payer: Copperpoint Commercial	$36.38
Rate for Payer: Health Net of AZ Commercial	$88.20
Rate for Payer: Health Net of AZ Medicare	$41.16
Rate for Payer: Humana of AZ Medicare	$22.05
Rate for Payer: Mercy Care Medicaid	$162.32
Rate for Payer: Self Pay Self Pay	$117.60
Rate for Payer: TriWest Medicare	$22.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.46

29131 APL FNG SPLNT DYNAMIC

Facility

$134.00

Service Code	CPT 29131
Hospital Charge Code	22282878
Hospital Revenue Code	450
Min. Negotiated Rate	$34.84
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna of AZ Commercial	$120.60
Rate for Payer: Bisbee Police All Plans	$34.84
Rate for Payer: Cash Price	$107.20
Rate for Payer: Self Pay Self Pay	$107.20

29131 APL FNG SPLNT DYNAMIC

Facility

$134.00

Service Code	CPT 29131
Hospital Charge Code	22282878
Hospital Revenue Code	450
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$120.60
Rate for Payer: Aetna of AZ Medicare	$37.52
Rate for Payer: AHCCCS Medicaid	$80.70
Rate for Payer: Allwell Medicaid	$80.70
Rate for Payer: Allwell Medicare	$20.10
Rate for Payer: Amerigroup Medicare	$20.10
Rate for Payer: APIPA Medicare/Medicaid	$50.05
Rate for Payer: AZCH Complete Medicaid	$80.70
Rate for Payer: AZCH Complete Medicare	$20.10
Rate for Payer: Banner UC Health Medicaid	$80.70
Rate for Payer: Banner UC Health Medicare	$20.10
Rate for Payer: Bisbee Police All Plans	$34.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.12
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cigna of AZ Commercial	$93.80
Rate for Payer: Copperpoint Commercial	$33.16
Rate for Payer: Health Net of AZ Commercial	$80.40
Rate for Payer: Health Net of AZ Medicare	$37.52
Rate for Payer: Humana of AZ Medicare	$20.10
Rate for Payer: Mercy Care Medicaid	$80.70
Rate for Payer: Self Pay Self Pay	$107.20
Rate for Payer: TriWest Medicare	$20.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.12

Know your out-of-pocket cost for care.

All Charges