Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

.FLUOR FOR NONINFECT AB (CELIAC COMP)

Facility

$735.00

Service Code	CPT 86255
Hospital Charge Code	22481445
Hospital Revenue Code	301
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Cash Price	$588.00
Rate for Payer: Self Pay Self Pay	$588.00

.FLUOR FOR NONINFECT AB (CELIAC COMP)

Facility

$735.00

Service Code	CPT 86255
Hospital Charge Code	22481445
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna of AZ Commercial	$661.50
Rate for Payer: Aetna of AZ Medicare	$205.80
Rate for Payer: AHCCCS Medicaid	$12.05
Rate for Payer: Allwell Medicaid	$12.05
Rate for Payer: Allwell Medicare	$110.25
Rate for Payer: Amerigroup Medicare	$110.25
Rate for Payer: APIPA Medicare/Medicaid	$274.52
Rate for Payer: AZCH Complete Medicaid	$12.05
Rate for Payer: AZCH Complete Medicare	$110.25
Rate for Payer: Banner UC Health Medicaid	$12.05
Rate for Payer: Banner UC Health Medicare	$110.25
Rate for Payer: Bisbee Police All Plans	$191.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$499.80
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cigna of AZ Commercial	$477.75
Rate for Payer: Copperpoint Commercial	$181.91
Rate for Payer: Health Net of AZ Commercial	$441.00
Rate for Payer: Health Net of AZ Medicare	$205.80
Rate for Payer: Humana of AZ Medicare	$110.25
Rate for Payer: Mercy Care Medicaid	$12.05
Rate for Payer: Self Pay Self Pay	$588.00
Rate for Payer: TriWest Medicare	$110.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$428.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$132.30

FLUOR NONINFECT AGENT AB TITER

Facility

$772.00

Service Code	CPT 86256
Hospital Charge Code	22481474
Hospital Revenue Code	302
Min. Negotiated Rate	$200.72
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Cash Price	$617.60
Rate for Payer: Self Pay Self Pay	$617.60

FLUOR NONINFECT AGENT AB TITER

Facility

$772.00

Service Code	CPT 86256
Hospital Charge Code	22481474
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Aetna of AZ Medicare	$216.16
Rate for Payer: AHCCCS Medicaid	$12.05
Rate for Payer: Allwell Medicaid	$12.05
Rate for Payer: Allwell Medicare	$115.80
Rate for Payer: Amerigroup Medicare	$115.80
Rate for Payer: APIPA Medicare/Medicaid	$288.34
Rate for Payer: AZCH Complete Medicaid	$12.05
Rate for Payer: AZCH Complete Medicare	$115.80
Rate for Payer: Banner UC Health Medicaid	$12.05
Rate for Payer: Banner UC Health Medicare	$115.80
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$524.96
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cigna of AZ Commercial	$501.80
Rate for Payer: Copperpoint Commercial	$191.07
Rate for Payer: Health Net of AZ Commercial	$463.20
Rate for Payer: Health Net of AZ Medicare	$216.16
Rate for Payer: Humana of AZ Medicare	$115.80
Rate for Payer: Mercy Care Medicaid	$12.05
Rate for Payer: Self Pay Self Pay	$617.60
Rate for Payer: TriWest Medicare	$115.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$450.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.96

Fluoroscopy Stage I

Facility

$535.00

Service Code	CPT 77003
Hospital Charge Code	27267838
Hospital Revenue Code	360
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$481.50
Rate for Payer: Aetna of AZ Commercial	$481.50
Rate for Payer: Aetna of AZ Medicare	$149.80
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$80.25
Rate for Payer: Amerigroup Medicare	$80.25
Rate for Payer: APIPA Medicare/Medicaid	$199.82
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$80.25
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$80.25
Rate for Payer: Bisbee Police All Plans	$139.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$363.80
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cash Price	$428.00
Rate for Payer: Cigna of AZ Commercial	$267.50
Rate for Payer: Copperpoint Commercial	$132.41
Rate for Payer: Health Net of AZ Commercial	$321.00
Rate for Payer: Health Net of AZ Medicare	$149.80
Rate for Payer: Humana of AZ Medicare	$80.25
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$428.00
Rate for Payer: TriWest Medicare	$80.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$311.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$96.30

Fluoroscopy Stage I

Facility

$535.00

Service Code	CPT 77003
Hospital Charge Code	27267838
Hospital Revenue Code	360
Min. Negotiated Rate	$139.10
Max. Negotiated Rate	$481.50
Rate for Payer: Aetna of AZ Commercial	$481.50
Rate for Payer: Bisbee Police All Plans	$139.10
Rate for Payer: Cash Price	$428.00
Rate for Payer: Self Pay Self Pay	$428.00

FLUoxetine 20 mg Cap [CQCH]

Facility

$0.09

Service Code	NDC 904578561
Hospital Charge Code	105923130
Hospital Revenue Code	251
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Aetna of AZ Medicare	$0.03
Rate for Payer: Allwell Medicare	$0.01
Rate for Payer: Amerigroup Medicare	$0.01
Rate for Payer: APIPA Medicare/Medicaid	$0.03
Rate for Payer: AZCH Complete Medicare	$0.01
Rate for Payer: Banner UC Health Medicare	$0.01
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.06
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of AZ Commercial	$0.06
Rate for Payer: Copperpoint Commercial	$0.02
Rate for Payer: Health Net of AZ Commercial	$0.05
Rate for Payer: Health Net of AZ Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.01
Rate for Payer: Self Pay Self Pay	$0.07
Rate for Payer: TriWest Medicare	$0.01
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

FLUoxetine 20 mg Cap [CQCH]

Facility

$0.09

Service Code	NDC 904578561
Hospital Charge Code	105923130
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of AZ Commercial	$0.08
Rate for Payer: Bisbee Police All Plans	$0.02
Rate for Payer: Cash Price	$0.07
Rate for Payer: Self Pay Self Pay	$0.07

fluticasone 110 mcg/inh Inh Aer w/adapter 12 gm [CQCH]

Facility

$223.16

Service Code	NDC 173071920
Hospital Charge Code	105923197
Hospital Revenue Code	251
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$200.84
Rate for Payer: Aetna of AZ Commercial	$200.84
Rate for Payer: Bisbee Police All Plans	$58.02
Rate for Payer: Cash Price	$178.53
Rate for Payer: Self Pay Self Pay	$178.53

fluticasone 110 mcg/inh Inh Aer w/adapter 12 gm [CQCH]

Facility

$223.16

Service Code	NDC 173071920
Hospital Charge Code	105923197
Hospital Revenue Code	251
Min. Negotiated Rate	$33.47
Max. Negotiated Rate	$200.84
Rate for Payer: Aetna of AZ Commercial	$200.84
Rate for Payer: Aetna of AZ Medicare	$62.48
Rate for Payer: Allwell Medicare	$33.47
Rate for Payer: Amerigroup Medicare	$33.47
Rate for Payer: APIPA Medicare/Medicaid	$83.35
Rate for Payer: AZCH Complete Medicare	$33.47
Rate for Payer: Banner UC Health Medicare	$33.47
Rate for Payer: Bisbee Police All Plans	$58.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$151.75
Rate for Payer: Cash Price	$178.53
Rate for Payer: Cigna of AZ Commercial	$145.05
Rate for Payer: Copperpoint Commercial	$55.23
Rate for Payer: Health Net of AZ Commercial	$133.90
Rate for Payer: Health Net of AZ Medicare	$62.48
Rate for Payer: Humana of AZ Medicare	$33.47
Rate for Payer: Self Pay Self Pay	$178.53
Rate for Payer: TriWest Medicare	$33.47
Rate for Payer: UnitedHealth Group of AZ Commercial	$130.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$40.17

fluticasone Nasal 0.05 mg/inh Spray [CQCH]

Facility

$7.42

Service Code	NDC 54327099
Hospital Charge Code	105949746
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$6.68
Rate for Payer: Aetna of AZ Commercial	$6.68
Rate for Payer: Bisbee Police All Plans	$1.93
Rate for Payer: Cash Price	$5.94
Rate for Payer: Self Pay Self Pay	$5.94

fluticasone Nasal 0.05 mg/inh Spray [CQCH]

Facility

$7.42

Service Code	NDC 54327099
Hospital Charge Code	105949746
Hospital Revenue Code	251
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$6.68
Rate for Payer: Aetna of AZ Commercial	$6.68
Rate for Payer: Aetna of AZ Medicare	$2.08
Rate for Payer: Allwell Medicare	$1.11
Rate for Payer: Amerigroup Medicare	$1.11
Rate for Payer: APIPA Medicare/Medicaid	$2.77
Rate for Payer: AZCH Complete Medicare	$1.11
Rate for Payer: Banner UC Health Medicare	$1.11
Rate for Payer: Bisbee Police All Plans	$1.93
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.05
Rate for Payer: Cash Price	$5.94
Rate for Payer: Cigna of AZ Commercial	$4.82
Rate for Payer: Copperpoint Commercial	$1.84
Rate for Payer: Health Net of AZ Commercial	$4.45
Rate for Payer: Health Net of AZ Medicare	$2.08
Rate for Payer: Humana of AZ Medicare	$1.11
Rate for Payer: Self Pay Self Pay	$5.94
Rate for Payer: TriWest Medicare	$1.11
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.34

Folate Level

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	633729
Hospital Revenue Code	301
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Folate Level

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	633729
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: AHCCCS Medicaid	$14.70
Rate for Payer: Allwell Medicaid	$14.70
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicaid	$14.70
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.70
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Mercy Care Medicaid	$14.70
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

.Folate Note LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	22311145
Hospital Revenue Code	306
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

.Folate Note LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	22311145
Hospital Revenue Code	306
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: AHCCCS Medicaid	$17.65
Rate for Payer: Allwell Medicaid	$17.65
Rate for Payer: Allwell Medicare	$38.85
Rate for Payer: Amerigroup Medicare	$38.85
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicaid	$17.65
Rate for Payer: AZCH Complete Medicare	$38.85
Rate for Payer: Banner UC Health Medicaid	$17.65
Rate for Payer: Banner UC Health Medicare	$38.85
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$38.85
Rate for Payer: Mercy Care Medicaid	$17.65
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$38.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

Folate, RBC LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	1906862
Hospital Revenue Code	301
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

Folate, RBC LC

Facility

$259.00

Service Code	CPT 82747
Hospital Charge Code	1906862
Hospital Revenue Code	301
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: AHCCCS Medicaid	$17.65
Rate for Payer: Allwell Medicaid	$17.65
Rate for Payer: Allwell Medicare	$38.85
Rate for Payer: Amerigroup Medicare	$38.85
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicaid	$17.65
Rate for Payer: AZCH Complete Medicare	$38.85
Rate for Payer: Banner UC Health Medicaid	$17.65
Rate for Payer: Banner UC Health Medicare	$38.85
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$168.35
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$38.85
Rate for Payer: Mercy Care Medicaid	$17.65
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$38.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

FOLEY CATH 18FR 30ML ALL SILICONE

Facility

$22.00

Hospital Charge Code	23641409
Hospital Revenue Code	270
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Cash Price	$17.60
Rate for Payer: Self Pay Self Pay	$17.60

FOLEY CATH 18FR 30ML ALL SILICONE

Facility

$22.00

Hospital Charge Code	23641409
Hospital Revenue Code	270
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$19.80
Rate for Payer: Aetna of AZ Commercial	$19.80
Rate for Payer: Aetna of AZ Medicare	$6.16
Rate for Payer: Allwell Medicare	$3.30
Rate for Payer: Amerigroup Medicare	$3.30
Rate for Payer: APIPA Medicare/Medicaid	$8.22
Rate for Payer: AZCH Complete Medicare	$3.30
Rate for Payer: Banner UC Health Medicare	$3.30
Rate for Payer: Bisbee Police All Plans	$5.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.96
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cigna of AZ Commercial	$15.40
Rate for Payer: Copperpoint Commercial	$5.44
Rate for Payer: Health Net of AZ Commercial	$13.20
Rate for Payer: Health Net of AZ Medicare	$6.16
Rate for Payer: Humana of AZ Medicare	$3.30
Rate for Payer: Self Pay Self Pay	$17.60
Rate for Payer: TriWest Medicare	$3.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.96

folic acid 1 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 62584089701
Hospital Charge Code	105923258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.09
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of AZ Commercial	$0.08
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.10
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.02

folic acid 1 mg Tab [CQCH]

Facility

$0.13

Service Code	NDC 62584089701
Hospital Charge Code	105923258
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna of AZ Commercial	$0.12
Rate for Payer: Bisbee Police All Plans	$0.03
Rate for Payer: Cash Price	$0.10
Rate for Payer: Self Pay Self Pay	$0.10

folic acid 5 mg/mL Inj Sol [CQCH]

Facility

$2.04

Service Code	NDC 39822110001
Hospital Charge Code	105923323
Hospital Revenue Code	251
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of AZ Commercial	$1.84
Rate for Payer: Bisbee Police All Plans	$0.53
Rate for Payer: Cash Price	$1.63
Rate for Payer: Self Pay Self Pay	$1.63

folic acid 5 mg/mL Inj Sol [CQCH]

Facility

$2.04

Service Code	NDC 39822110001
Hospital Charge Code	105923323
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of AZ Commercial	$1.84
Rate for Payer: Aetna of AZ Medicare	$0.57
Rate for Payer: Allwell Medicare	$0.31
Rate for Payer: Amerigroup Medicare	$0.31
Rate for Payer: APIPA Medicare/Medicaid	$0.76
Rate for Payer: AZCH Complete Medicare	$0.31
Rate for Payer: Banner UC Health Medicare	$0.31
Rate for Payer: Bisbee Police All Plans	$0.53
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.39
Rate for Payer: Cash Price	$1.63
Rate for Payer: Cigna of AZ Commercial	$1.33
Rate for Payer: Copperpoint Commercial	$0.50
Rate for Payer: Health Net of AZ Commercial	$1.22
Rate for Payer: Health Net of AZ Medicare	$0.57
Rate for Payer: Humana of AZ Medicare	$0.31
Rate for Payer: Self Pay Self Pay	$1.63
Rate for Payer: TriWest Medicare	$0.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.37

Folic Acid(FOLATE)

Facility

$181.00

Service Code	CPT 82746
Hospital Charge Code	22540594
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: AHCCCS Medicaid	$14.70
Rate for Payer: Allwell Medicaid	$14.70
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicaid	$14.70
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.70
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Mercy Care Medicaid	$14.70
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

Know your out-of-pocket cost for care.

All Charges