Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

29505 APPL SPLINT LONG LEG

Facility

$306.00

Service Code	CPT 29505
Hospital Charge Code	22282885
Hospital Revenue Code	450
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$275.40
Rate for Payer: Aetna of AZ Medicare	$85.68
Rate for Payer: AHCCCS Medicaid	$102.36
Rate for Payer: Allwell Medicaid	$102.36
Rate for Payer: Allwell Medicare	$48.96
Rate for Payer: Amerigroup Medicare	$48.96
Rate for Payer: APIPA Medicare/Medicaid	$114.29
Rate for Payer: AZCH Complete Medicaid	$102.36
Rate for Payer: AZCH Complete Medicare	$48.96
Rate for Payer: Banner UC Health Medicaid	$102.36
Rate for Payer: Banner UC Health Medicare	$48.96
Rate for Payer: Bisbee Police All Plans	$79.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$208.08
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna of AZ Commercial	$214.20
Rate for Payer: Copperpoint Commercial	$75.73
Rate for Payer: Health Net of AZ Commercial	$183.60
Rate for Payer: Health Net of AZ Medicare	$85.68
Rate for Payer: Humana of AZ Medicare	$48.96
Rate for Payer: Mercy Care Medicaid	$102.36
Rate for Payer: Self Pay Self Pay	$244.80
Rate for Payer: TriWest Medicare	$48.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.08

29505 APPL SPLINT LONG LEG

Facility

$306.00

Service Code	CPT 29505
Hospital Charge Code	22282885
Hospital Revenue Code	450
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$275.40
Rate for Payer: Aetna of AZ Commercial	$275.40
Rate for Payer: Bisbee Police All Plans	$79.56
Rate for Payer: Cash Price	$244.80
Rate for Payer: Self Pay Self Pay	$244.80

29515 APPL SPLINT SHRT LEG

Facility

$303.00

Service Code	CPT 29515
Hospital Charge Code	22282886
Hospital Revenue Code	450
Min. Negotiated Rate	$78.78
Max. Negotiated Rate	$272.70
Rate for Payer: Aetna of AZ Commercial	$272.70
Rate for Payer: Bisbee Police All Plans	$78.78
Rate for Payer: Cash Price	$242.40
Rate for Payer: Self Pay Self Pay	$242.40

29515 APPL SPLINT SHRT LEG

Facility

$303.00

Service Code	CPT 29515
Hospital Charge Code	22282886
Hospital Revenue Code	450
Min. Negotiated Rate	$48.48
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$272.70
Rate for Payer: Aetna of AZ Medicare	$84.84
Rate for Payer: AHCCCS Medicaid	$102.36
Rate for Payer: Allwell Medicaid	$102.36
Rate for Payer: Allwell Medicare	$48.48
Rate for Payer: Amerigroup Medicare	$48.48
Rate for Payer: APIPA Medicare/Medicaid	$113.17
Rate for Payer: AZCH Complete Medicaid	$102.36
Rate for Payer: AZCH Complete Medicare	$48.48
Rate for Payer: Banner UC Health Medicaid	$102.36
Rate for Payer: Banner UC Health Medicare	$48.48
Rate for Payer: Bisbee Police All Plans	$78.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$206.04
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cash Price	$242.40
Rate for Payer: Cigna of AZ Commercial	$212.10
Rate for Payer: Copperpoint Commercial	$74.99
Rate for Payer: Health Net of AZ Commercial	$181.80
Rate for Payer: Health Net of AZ Medicare	$84.84
Rate for Payer: Humana of AZ Medicare	$48.48
Rate for Payer: Mercy Care Medicaid	$102.36
Rate for Payer: Self Pay Self Pay	$242.40
Rate for Payer: TriWest Medicare	$48.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.54

29520 STRAPPING HIP

Facility

$139.00

Service Code	CPT 29520
Hospital Charge Code	22282887
Hospital Revenue Code	450
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

29520 STRAPPING HIP

Facility

$139.00

Service Code	CPT 29520
Hospital Charge Code	22282887
Hospital Revenue Code	450
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$125.10
Rate for Payer: Aetna of AZ Medicare	$38.92
Rate for Payer: AHCCCS Medicaid	$81.16
Rate for Payer: Allwell Medicaid	$81.16
Rate for Payer: Allwell Medicare	$22.24
Rate for Payer: Amerigroup Medicare	$22.24
Rate for Payer: APIPA Medicare/Medicaid	$51.92
Rate for Payer: AZCH Complete Medicaid	$81.16
Rate for Payer: AZCH Complete Medicare	$22.24
Rate for Payer: Banner UC Health Medicaid	$81.16
Rate for Payer: Banner UC Health Medicare	$22.24
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: Cash Price	$111.20
Rate for Payer: Cigna of AZ Commercial	$97.30
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	$22.24
Rate for Payer: Mercy Care Medicaid	$81.16
Rate for Payer: Self Pay Self Pay	$111.20
Rate for Payer: TriWest Medicare	$22.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.02

29530 STRAPPING KNEE

Facility

$168.00

Service Code	CPT 29530
Hospital Charge Code	22282888
Hospital Revenue Code	450
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Cash Price	$134.40
Rate for Payer: Self Pay Self Pay	$134.40

29530 STRAPPING KNEE

Facility

$168.00

Service Code	CPT 29530
Hospital Charge Code	22282888
Hospital Revenue Code	450
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$151.20
Rate for Payer: Aetna of AZ Medicare	$47.04
Rate for Payer: AHCCCS Medicaid	$81.16
Rate for Payer: Allwell Medicaid	$81.16
Rate for Payer: Allwell Medicare	$26.88
Rate for Payer: Amerigroup Medicare	$26.88
Rate for Payer: APIPA Medicare/Medicaid	$62.75
Rate for Payer: AZCH Complete Medicaid	$81.16
Rate for Payer: AZCH Complete Medicare	$26.88
Rate for Payer: Banner UC Health Medicaid	$81.16
Rate for Payer: Banner UC Health Medicare	$26.88
Rate for Payer: Bisbee Police All Plans	$43.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$114.24
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cigna of AZ Commercial	$117.60
Rate for Payer: Copperpoint Commercial	$41.58
Rate for Payer: Health Net of AZ Commercial	$100.80
Rate for Payer: Health Net of AZ Medicare	$47.04
Rate for Payer: Humana of AZ Medicare	$26.88
Rate for Payer: Mercy Care Medicaid	$81.16
Rate for Payer: Self Pay Self Pay	$134.40
Rate for Payer: TriWest Medicare	$26.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.24

29540 STRAPPING ANKLE

Facility

$138.00

Service Code	CPT 29540
Hospital Charge Code	22282889
Hospital Revenue Code	450
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Aetna of AZ Medicare	$38.64
Rate for Payer: AHCCCS Medicaid	$102.36
Rate for Payer: Allwell Medicaid	$102.36
Rate for Payer: Allwell Medicare	$22.08
Rate for Payer: Amerigroup Medicare	$22.08
Rate for Payer: APIPA Medicare/Medicaid	$51.54
Rate for Payer: AZCH Complete Medicaid	$102.36
Rate for Payer: AZCH Complete Medicare	$22.08
Rate for Payer: Banner UC Health Medicaid	$102.36
Rate for Payer: Banner UC Health Medicare	$22.08
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$93.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cigna of AZ Commercial	$96.60
Rate for Payer: Copperpoint Commercial	$34.16
Rate for Payer: Health Net of AZ Commercial	$82.80
Rate for Payer: Health Net of AZ Medicare	$38.64
Rate for Payer: Humana of AZ Medicare	$22.08
Rate for Payer: Mercy Care Medicaid	$102.36
Rate for Payer: Self Pay Self Pay	$110.40
Rate for Payer: TriWest Medicare	$22.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.84

29540 STRAPPING ANKLE

Facility

$138.00

Service Code	CPT 29540
Hospital Charge Code	22282889
Hospital Revenue Code	450
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Cash Price	$110.40
Rate for Payer: Self Pay Self Pay	$110.40

29550 STRAPPING TOES

Facility

$134.00

Service Code	CPT 29550
Hospital Charge Code	22282890
Hospital Revenue Code	450
Min. Negotiated Rate	$21.44
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	$40.35
Rate for Payer: Allwell Medicaid	$40.35
Rate for Payer: Allwell Medicare	$21.44
Rate for Payer: Amerigroup Medicare	$21.44
Rate for Payer: APIPA Medicare/Medicaid	$50.05
Rate for Payer: AZCH Complete Medicaid	$40.35
Rate for Payer: AZCH Complete Medicare	$21.44
Rate for Payer: Banner UC Health Medicaid	$40.35
Rate for Payer: Banner UC Health Medicare	$21.44
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	$21.44
Rate for Payer: Mercy Care Medicaid	$40.35
Rate for Payer: Self Pay Self Pay	$107.20
Rate for Payer: TriWest Medicare	$21.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.12

29550 STRAPPING TOES

Facility

$134.00

Service Code	CPT 29550
Hospital Charge Code	22282890
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

29580 STRAPPING UNNA BOOT

Facility

$207.00

Service Code	CPT 29580
Hospital Charge Code	22282891
Hospital Revenue Code	450
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna of AZ Commercial	$186.30
Rate for Payer: Bisbee Police All Plans	$53.82
Rate for Payer: Cash Price	$165.60
Rate for Payer: Self Pay Self Pay	$165.60

29580 STRAPPING UNNA BOOT

Facility

$207.00

Service Code	CPT 29580
Hospital Charge Code	22282891
Hospital Revenue Code	450
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$186.30
Rate for Payer: Aetna of AZ Medicare	$57.96
Rate for Payer: AHCCCS Medicaid	$102.36
Rate for Payer: Allwell Medicaid	$102.36
Rate for Payer: Allwell Medicare	$33.12
Rate for Payer: Amerigroup Medicare	$33.12
Rate for Payer: APIPA Medicare/Medicaid	$77.31
Rate for Payer: AZCH Complete Medicaid	$102.36
Rate for Payer: AZCH Complete Medicare	$33.12
Rate for Payer: Banner UC Health Medicaid	$102.36
Rate for Payer: Banner UC Health Medicare	$33.12
Rate for Payer: Bisbee Police All Plans	$53.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$140.76
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cigna of AZ Commercial	$144.90
Rate for Payer: Copperpoint Commercial	$51.23
Rate for Payer: Health Net of AZ Commercial	$124.20
Rate for Payer: Health Net of AZ Medicare	$57.96
Rate for Payer: Humana of AZ Medicare	$33.12
Rate for Payer: Mercy Care Medicaid	$102.36
Rate for Payer: Self Pay Self Pay	$165.60
Rate for Payer: TriWest Medicare	$33.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.26

29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL

Facility

$2,951.00

Service Code	CPT 29881
Hospital Charge Code	23206694
Hospital Revenue Code	360
Min. Negotiated Rate	$472.16
Max. Negotiated Rate	$3,914.00
Rate for Payer: Aetna of AZ Commercial	$2,655.90
Rate for Payer: Aetna of AZ Medicare	$826.28
Rate for Payer: AHCCCS Medicaid	$2,052.04
Rate for Payer: Allwell Medicaid	$2,052.04
Rate for Payer: Allwell Medicare	$472.16
Rate for Payer: Amerigroup Medicare	$472.16
Rate for Payer: APIPA Medicare/Medicaid	$1,102.20
Rate for Payer: AZCH Complete Medicaid	$2,052.04
Rate for Payer: AZCH Complete Medicare	$472.16
Rate for Payer: Banner UC Health Medicaid	$2,052.04
Rate for Payer: Banner UC Health Medicare	$472.16
Rate for Payer: Bisbee Police All Plans	$767.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,006.68
Rate for Payer: Cash Price	$2,360.80
Rate for Payer: Cash Price	$2,360.80
Rate for Payer: Cigna of AZ Commercial	$1,475.50
Rate for Payer: Copperpoint Commercial	$730.37
Rate for Payer: Health Net of AZ Commercial	$1,770.60
Rate for Payer: Health Net of AZ Medicare	$826.28
Rate for Payer: Humana of AZ Medicare	$472.16
Rate for Payer: Mercy Care Medicaid	$2,052.04
Rate for Payer: Self Pay Self Pay	$2,360.80
Rate for Payer: TriWest Medicare	$472.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$531.18

29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL

Facility

$2,951.00

Service Code	CPT 29881
Hospital Charge Code	23206694
Hospital Revenue Code	360
Min. Negotiated Rate	$767.26
Max. Negotiated Rate	$2,655.90
Rate for Payer: Aetna of AZ Commercial	$2,655.90
Rate for Payer: Bisbee Police All Plans	$767.26
Rate for Payer: Cash Price	$2,360.80
Rate for Payer: Self Pay Self Pay	$2,360.80

3014F Screening mammography review

Facility

$0.01

Service Code	CPT 3014F
Hospital Charge Code	22540652
Hospital Revenue Code	403
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

3014F Screening mammography review

Facility

$0.01

Service Code	CPT 3014F
Hospital Charge Code	22540652
Hospital Revenue Code	403
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

3017F Colonoscopy in the last 10 years

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540656
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

3017F Colonoscopy in the last 10 years

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540656
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

3017F Fecal occult Blood in current year

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540654
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

3017F Fecal occult Blood in current year

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540654
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

3017F Flex Sigmoid in the last 5 years

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540655
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

3017F Flex Sigmoid in the last 5 years

Facility

$0.01

Service Code	CPT 3017F
Hospital Charge Code	22540655
Hospital Revenue Code	750
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Self Pay Self Pay	$0.01

30300 RMV FB NOSE

Facility

$389.00

Service Code	CPT 30300
Hospital Charge Code	22282892
Hospital Revenue Code	450
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$350.10
Rate for Payer: Aetna of AZ Commercial	$350.10
Rate for Payer: Bisbee Police All Plans	$101.14
Rate for Payer: Cash Price	$311.20
Rate for Payer: Self Pay Self Pay	$311.20

Know your out-of-pocket cost for care.

All Charges