Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

IV - LACTATED RINGERS : 1000 ML

Facility

$30.00

Service Code	CPT J7120
Hospital Charge Code	22524011
Hospital Revenue Code	250
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

IV - LACTATED RINGERS : 1000 ML

Facility

$30.00

Service Code	CPT J7120
Hospital Charge Code	22524011
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: AHCCCS Medicaid	$4.76
Rate for Payer: Allwell Medicaid	$4.76
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicaid	$4.76
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicaid	$4.76
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Mercy Care Medicaid	$4.76
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

IV-NORMAL SALINE (0.9%) : 1000 ML

Facility

$30.00

Hospital Charge Code	22355217
Hospital Revenue Code	250
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

IV-NORMAL SALINE (0.9%) : 1000 ML

Facility

$30.00

Hospital Charge Code	22355217
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

IV-NORMAL SALINE (0.9%) : 250 ML

Facility

$30.00

Hospital Charge Code	22524012
Hospital Revenue Code	250
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Self Pay Self Pay	$24.00

IV-NORMAL SALINE (0.9%) : 250 ML

Facility

$30.00

Hospital Charge Code	22524012
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of AZ Commercial	$27.00
Rate for Payer: Aetna of AZ Medicare	$8.40
Rate for Payer: Allwell Medicare	$4.50
Rate for Payer: Amerigroup Medicare	$4.50
Rate for Payer: APIPA Medicare/Medicaid	$11.20
Rate for Payer: AZCH Complete Medicare	$4.50
Rate for Payer: Banner UC Health Medicare	$4.50
Rate for Payer: Bisbee Police All Plans	$7.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$20.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cigna of AZ Commercial	$19.50
Rate for Payer: Copperpoint Commercial	$7.42
Rate for Payer: Health Net of AZ Commercial	$18.00
Rate for Payer: Health Net of AZ Medicare	$8.40
Rate for Payer: Humana of AZ Medicare	$4.50
Rate for Payer: Self Pay Self Pay	$24.00
Rate for Payer: TriWest Medicare	$4.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$17.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.40

IV - NORMAL SALINE (0.9%) : 3000ML

Facility

$45.00

Hospital Charge Code	22354807
Hospital Revenue Code	270
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Aetna of AZ Medicare	$12.60
Rate for Payer: Allwell Medicare	$6.75
Rate for Payer: Amerigroup Medicare	$6.75
Rate for Payer: APIPA Medicare/Medicaid	$16.81
Rate for Payer: AZCH Complete Medicare	$6.75
Rate for Payer: Banner UC Health Medicare	$6.75
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$30.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of AZ Commercial	$31.50
Rate for Payer: Copperpoint Commercial	$11.14
Rate for Payer: Health Net of AZ Commercial	$27.00
Rate for Payer: Health Net of AZ Medicare	$12.60
Rate for Payer: Humana of AZ Medicare	$6.75
Rate for Payer: Self Pay Self Pay	$36.00
Rate for Payer: TriWest Medicare	$6.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$26.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.10

IV - NORMAL SALINE (0.9%) : 3000ML

Facility

$45.00

Hospital Charge Code	22354807
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna of AZ Commercial	$40.50
Rate for Payer: Bisbee Police All Plans	$11.70
Rate for Payer: Cash Price	$36.00
Rate for Payer: Self Pay Self Pay	$36.00

IV-NORMAL SALINE (0.9%) : 500 ML

Facility

$29.00

Hospital Charge Code	22355375
Hospital Revenue Code	270
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: Allwell Medicare	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.35
Rate for Payer: Banner UC Health Medicare	$4.35
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.35
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

IV-NORMAL SALINE (0.9%) : 500 ML

Facility

$29.00

Hospital Charge Code	22355375
Hospital Revenue Code	270
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

IV PRIMARY TUBING HOSPIRA

Facility

$62.00

Hospital Charge Code	22355539
Hospital Revenue Code	270
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

IV PRIMARY TUBING HOSPIRA

Facility

$62.00

Hospital Charge Code	22355539
Hospital Revenue Code	270
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.30
Rate for Payer: Amerigroup Medicare	$9.30
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.30
Rate for Payer: Banner UC Health Medicare	$9.30
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$43.40
Rate for Payer: Copperpoint Commercial	$15.34
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.30
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

IV PRIMARY TUBING OLD PIGGYBACK 12664-28

Facility

$29.00

Hospital Charge Code	22355547
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Aetna of AZ Medicare	$8.12
Rate for Payer: Allwell Medicare	$4.35
Rate for Payer: Amerigroup Medicare	$4.35
Rate for Payer: APIPA Medicare/Medicaid	$10.83
Rate for Payer: AZCH Complete Medicare	$4.35
Rate for Payer: Banner UC Health Medicare	$4.35
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$19.72
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cigna of AZ Commercial	$20.30
Rate for Payer: Copperpoint Commercial	$7.18
Rate for Payer: Health Net of AZ Commercial	$17.40
Rate for Payer: Health Net of AZ Medicare	$8.12
Rate for Payer: Humana of AZ Medicare	$4.35
Rate for Payer: Self Pay Self Pay	$23.20
Rate for Payer: TriWest Medicare	$4.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$16.91
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.22

IV PRIMARY TUBING OLD PIGGYBACK 12664-28

Facility

$29.00

Hospital Charge Code	22355547
Hospital Revenue Code	272
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna of AZ Commercial	$26.10
Rate for Payer: Bisbee Police All Plans	$7.54
Rate for Payer: Cash Price	$23.20
Rate for Payer: Self Pay Self Pay	$23.20

JAK2 Mutation Analysis, Qual LC

Facility

$1,197.00

Service Code	CPT 81270
Hospital Charge Code	2029233
Hospital Revenue Code	301
Min. Negotiated Rate	$311.22
Max. Negotiated Rate	$1,077.30
Rate for Payer: Aetna of AZ Commercial	$1,077.30
Rate for Payer: Bisbee Police All Plans	$311.22
Rate for Payer: Cash Price	$957.60
Rate for Payer: Self Pay Self Pay	$957.60

JAK2 Mutation Analysis, Qual LC

Facility

$1,197.00

Service Code	CPT 81270
Hospital Charge Code	2029233
Hospital Revenue Code	301
Min. Negotiated Rate	$91.66
Max. Negotiated Rate	$1,077.30
Rate for Payer: Aetna of AZ Commercial	$1,077.30
Rate for Payer: Aetna of AZ Medicare	$335.16
Rate for Payer: AHCCCS Medicaid	$91.66
Rate for Payer: Allwell Medicaid	$91.66
Rate for Payer: Allwell Medicare	$179.55
Rate for Payer: Amerigroup Medicare	$179.55
Rate for Payer: APIPA Medicare/Medicaid	$447.08
Rate for Payer: AZCH Complete Medicaid	$91.66
Rate for Payer: AZCH Complete Medicare	$179.55
Rate for Payer: Banner UC Health Medicaid	$91.66
Rate for Payer: Banner UC Health Medicare	$179.55
Rate for Payer: Bisbee Police All Plans	$311.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$813.96
Rate for Payer: Cash Price	$957.60
Rate for Payer: Cash Price	$957.60
Rate for Payer: Cigna of AZ Commercial	$778.05
Rate for Payer: Copperpoint Commercial	$296.26
Rate for Payer: Health Net of AZ Commercial	$718.20
Rate for Payer: Health Net of AZ Medicare	$335.16
Rate for Payer: Humana of AZ Medicare	$179.55
Rate for Payer: Mercy Care Medicaid	$91.66
Rate for Payer: Self Pay Self Pay	$957.60
Rate for Payer: TriWest Medicare	$179.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$697.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$215.46

Kelly plication

Facility

$1,775.00

Service Code	CPT 57220
Hospital Charge Code	27267789
Hospital Revenue Code	360
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Bisbee Police All Plans	$461.50
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Self Pay Self Pay	$1,420.00

Kelly plication

Facility

$1,775.00

Service Code	CPT 57220
Hospital Charge Code	27267789
Hospital Revenue Code	360
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$6,393.84
Rate for Payer: Aetna of AZ Commercial	$1,597.50
Rate for Payer: Aetna of AZ Medicare	$497.00
Rate for Payer: AHCCCS Medicaid	$6,393.84
Rate for Payer: Allwell Medicaid	$6,393.84
Rate for Payer: Allwell Medicare	$266.25
Rate for Payer: Amerigroup Medicare	$266.25
Rate for Payer: APIPA Medicare/Medicaid	$662.96
Rate for Payer: AZCH Complete Medicaid	$6,393.84
Rate for Payer: AZCH Complete Medicare	$266.25
Rate for Payer: Banner UC Health Medicaid	$6,393.84
Rate for Payer: Banner UC Health Medicare	$266.25
Rate for Payer: Bisbee Police All Plans	$461.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,207.00
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Cash Price	$1,420.00
Rate for Payer: Cigna of AZ Commercial	$887.50
Rate for Payer: Copperpoint Commercial	$439.31
Rate for Payer: Health Net of AZ Commercial	$1,065.00
Rate for Payer: Health Net of AZ Medicare	$497.00
Rate for Payer: Humana of AZ Medicare	$266.25
Rate for Payer: Mercy Care Medicaid	$6,393.84
Rate for Payer: Self Pay Self Pay	$1,420.00
Rate for Payer: TriWest Medicare	$266.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,540.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$319.50

ketamine inj concentrate 500 mg/5 mL Sol [CQCH]

Facility

$1.49

Service Code	NDC 409205105
Hospital Charge Code	113868946
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of AZ Commercial	$1.34
Rate for Payer: Aetna of AZ Medicare	$0.42
Rate for Payer: Allwell Medicare	$0.22
Rate for Payer: Amerigroup Medicare	$0.22
Rate for Payer: APIPA Medicare/Medicaid	$0.56
Rate for Payer: AZCH Complete Medicare	$0.22
Rate for Payer: Banner UC Health Medicare	$0.22
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.01
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cigna of AZ Commercial	$0.97
Rate for Payer: Copperpoint Commercial	$0.37
Rate for Payer: Health Net of AZ Commercial	$0.89
Rate for Payer: Health Net of AZ Medicare	$0.42
Rate for Payer: Humana of AZ Medicare	$0.22
Rate for Payer: Self Pay Self Pay	$1.19
Rate for Payer: TriWest Medicare	$0.22
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.27

ketamine inj concentrate 500 mg/5 mL Sol [CQCH]

Facility

$1.49

Service Code	NDC 409205105
Hospital Charge Code	113868946
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna of AZ Commercial	$1.34
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Cash Price	$1.19
Rate for Payer: Self Pay Self Pay	$1.19

Ketone Serum

Facility

$178.00

Service Code	CPT 82009
Hospital Charge Code	887702
Hospital Revenue Code	302
Min. Negotiated Rate	$46.28
Max. Negotiated Rate	$160.20
Rate for Payer: Aetna of AZ Commercial	$160.20
Rate for Payer: Bisbee Police All Plans	$46.28
Rate for Payer: Cash Price	$142.40
Rate for Payer: Self Pay Self Pay	$142.40

Ketone Serum

Facility

$178.00

Service Code	CPT 82009
Hospital Charge Code	887702
Hospital Revenue Code	302
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$160.20
Rate for Payer: Aetna of AZ Commercial	$160.20
Rate for Payer: Aetna of AZ Medicare	$49.84
Rate for Payer: AHCCCS Medicaid	$4.52
Rate for Payer: Allwell Medicaid	$4.52
Rate for Payer: Allwell Medicare	$26.70
Rate for Payer: Amerigroup Medicare	$26.70
Rate for Payer: APIPA Medicare/Medicaid	$66.48
Rate for Payer: AZCH Complete Medicaid	$4.52
Rate for Payer: AZCH Complete Medicare	$26.70
Rate for Payer: Banner UC Health Medicaid	$4.52
Rate for Payer: Banner UC Health Medicare	$26.70
Rate for Payer: Bisbee Police All Plans	$46.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.04
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cigna of AZ Commercial	$115.70
Rate for Payer: Copperpoint Commercial	$44.06
Rate for Payer: Health Net of AZ Commercial	$106.80
Rate for Payer: Health Net of AZ Medicare	$49.84
Rate for Payer: Humana of AZ Medicare	$26.70
Rate for Payer: Mercy Care Medicaid	$4.52
Rate for Payer: Self Pay Self Pay	$142.40
Rate for Payer: TriWest Medicare	$26.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$103.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.04

ketorolac 15 mg Inj Sol [CQCH]

Facility

$1.80

Service Code	HCPCS J1885
Hospital Charge Code	105927425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna of AZ Commercial	$1.62
Rate for Payer: Aetna of AZ Medicare	$0.50
Rate for Payer: AHCCCS Medicaid	$1.12
Rate for Payer: Allwell Medicaid	$1.12
Rate for Payer: Allwell Medicare	$0.27
Rate for Payer: Amerigroup Medicare	$0.27
Rate for Payer: APIPA Medicare/Medicaid	$0.67
Rate for Payer: AZCH Complete Medicaid	$1.12
Rate for Payer: AZCH Complete Medicare	$0.27
Rate for Payer: Banner UC Health Medicaid	$1.12
Rate for Payer: Banner UC Health Medicare	$0.27
Rate for Payer: Bisbee Police All Plans	$0.47
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.22
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cigna of AZ Commercial	$1.17
Rate for Payer: Copperpoint Commercial	$0.45
Rate for Payer: Health Net of AZ Commercial	$1.08
Rate for Payer: Health Net of AZ Medicare	$0.50
Rate for Payer: Humana of AZ Medicare	$0.27
Rate for Payer: Mercy Care Medicaid	$1.12
Rate for Payer: Self Pay Self Pay	$1.44
Rate for Payer: TriWest Medicare	$0.27
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.32

ketorolac 15 mg Inj Sol [CQCH]

Facility

$1.80

Service Code	HCPCS J1885
Hospital Charge Code	105927425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna of AZ Commercial	$1.62
Rate for Payer: Bisbee Police All Plans	$0.47
Rate for Payer: Cash Price	$1.44
Rate for Payer: Self Pay Self Pay	$1.44

ketorolac 30 mg Inj Sol [CQCH]

Facility

$0.88

Service Code	HCPCS J1885
Hospital Charge Code	105927498
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.79
Rate for Payer: Aetna of AZ Commercial	$0.79
Rate for Payer: Bisbee Police All Plans	$0.23
Rate for Payer: Cash Price	$0.70
Rate for Payer: Self Pay Self Pay	$0.70

Know your out-of-pocket cost for care.

All Charges