Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

morphine 10 mg/5 mL Oral Sol UD [CQCH]

Facility

$0.24

Service Code	NDC 66689003250
Hospital Charge Code	105964301
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.19
Rate for Payer: Self Pay Self Pay	$0.19

morphine 10 mg/5 mL Oral Sol UD [CQCH]

Facility

$0.24

Service Code	NDC 66689003250
Hospital Charge Code	105964301
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of AZ Commercial	$0.22
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	$0.09
Rate for Payer: AZCH Complete Medicare	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.16
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.16
Rate for Payer: Copperpoint Commercial	$0.06
Rate for Payer: Health Net of AZ Commercial	$0.14
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	$0.19
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

morphine 10 mg/mL preservative-free Sol[CQCH]

Facility

$1.94

Service Code	HCPCS J2274
Hospital Charge Code	169360742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna of AZ Commercial	$1.75
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Cash Price	$1.55
Rate for Payer: Self Pay Self Pay	$1.55

morphine 10 mg/mL preservative-free Sol[CQCH]

Facility

$1.94

Service Code	HCPCS J2274
Hospital Charge Code	169360742
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna of AZ Commercial	$1.75
Rate for Payer: Aetna of AZ Medicare	$0.54
Rate for Payer: AHCCCS Medicaid	$17.30
Rate for Payer: Allwell Medicaid	$17.30
Rate for Payer: Allwell Medicare	$0.29
Rate for Payer: Amerigroup Medicare	$0.29
Rate for Payer: APIPA Medicare/Medicaid	$0.72
Rate for Payer: AZCH Complete Medicaid	$17.30
Rate for Payer: AZCH Complete Medicare	$0.29
Rate for Payer: Banner UC Health Medicaid	$17.30
Rate for Payer: Banner UC Health Medicare	$0.29
Rate for Payer: Bisbee Police All Plans	$0.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.32
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna of AZ Commercial	$1.26
Rate for Payer: Copperpoint Commercial	$0.48
Rate for Payer: Health Net of AZ Commercial	$1.16
Rate for Payer: Health Net of AZ Medicare	$0.54
Rate for Payer: Humana of AZ Medicare	$0.29
Rate for Payer: Mercy Care Medicaid	$17.30
Rate for Payer: Self Pay Self Pay	$1.55
Rate for Payer: TriWest Medicare	$0.29
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.35

morphine 15 mg ER Tab [CQCH]

Facility

$0.49

Service Code	NDC 406831562
Hospital Charge Code	105932700
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
Rate for Payer: Bisbee Police All Plans	$0.13
Rate for Payer: Cash Price	$0.39
Rate for Payer: Self Pay Self Pay	$0.39

morphine 15 mg ER Tab [CQCH]

Facility

$0.49

Service Code	NDC 406831562
Hospital Charge Code	105932700
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.44
Rate for Payer: Aetna of AZ Commercial	$0.44
Rate for Payer: Aetna of AZ Medicare	$0.14
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.18
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.33
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of AZ Commercial	$0.32
Rate for Payer: Copperpoint Commercial	$0.12
Rate for Payer: Health Net of AZ Commercial	$0.29
Rate for Payer: Health Net of AZ Medicare	$0.14
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.39
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.29
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.09

morphine 15 mg Tab-IR [CQCH]

Facility

$0.33

Service Code	NDC 832027311
Hospital Charge Code	145868627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.22
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.20
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.26
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

morphine 15 mg Tab-IR [CQCH]

Facility

$0.33

Service Code	NDC 832027311
Hospital Charge Code	145868627
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.27
Rate for Payer: Self Pay Self Pay	$0.26

morphine 2 mg/ 1 mL Inj Soln [CQCH]

Facility

$1.73

Service Code	HCPCS J2270
Hospital Charge Code	105932635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Cash Price	$1.38
Rate for Payer: Self Pay Self Pay	$1.38

morphine 2 mg/ 1 mL Inj Soln [CQCH]

Facility

$1.73

Service Code	HCPCS J2270
Hospital Charge Code	105932635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna of AZ Commercial	$1.56
Rate for Payer: Aetna of AZ Medicare	$0.48
Rate for Payer: AHCCCS Medicaid	$4.68
Rate for Payer: Allwell Medicaid	$4.68
Rate for Payer: Allwell Medicare	$0.26
Rate for Payer: Amerigroup Medicare	$0.26
Rate for Payer: APIPA Medicare/Medicaid	$0.65
Rate for Payer: AZCH Complete Medicaid	$4.68
Rate for Payer: AZCH Complete Medicare	$0.26
Rate for Payer: Banner UC Health Medicaid	$4.68
Rate for Payer: Banner UC Health Medicare	$0.26
Rate for Payer: Bisbee Police All Plans	$0.45
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.18
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cash Price	$1.38
Rate for Payer: Cigna of AZ Commercial	$1.12
Rate for Payer: Copperpoint Commercial	$0.43
Rate for Payer: Health Net of AZ Commercial	$1.04
Rate for Payer: Health Net of AZ Medicare	$0.48
Rate for Payer: Humana of AZ Medicare	$0.26
Rate for Payer: Mercy Care Medicaid	$4.68
Rate for Payer: Self Pay Self Pay	$1.38
Rate for Payer: TriWest Medicare	$0.26
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.31

morphine 4 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.68

Service Code	HCPCS J2270
Hospital Charge Code	105932899
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.51
Rate for Payer: Aetna of AZ Commercial	$1.51
Rate for Payer: Bisbee Police All Plans	$0.44
Rate for Payer: Cash Price	$1.34
Rate for Payer: Self Pay Self Pay	$1.34

morphine 4 mg/ 1 mL Inj Sol [CQCH]

Facility

$1.68

Service Code	HCPCS J2270
Hospital Charge Code	105932899
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna of AZ Commercial	$1.51
Rate for Payer: Aetna of AZ Medicare	$0.47
Rate for Payer: AHCCCS Medicaid	$4.68
Rate for Payer: Allwell Medicaid	$4.68
Rate for Payer: Allwell Medicare	$0.25
Rate for Payer: Amerigroup Medicare	$0.25
Rate for Payer: APIPA Medicare/Medicaid	$0.63
Rate for Payer: AZCH Complete Medicaid	$4.68
Rate for Payer: AZCH Complete Medicare	$0.25
Rate for Payer: Banner UC Health Medicaid	$4.68
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Bisbee Police All Plans	$0.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.14
Rate for Payer: Cash Price	$1.34
Rate for Payer: Cash Price	$1.34
Rate for Payer: Cigna of AZ Commercial	$1.09
Rate for Payer: Copperpoint Commercial	$0.42
Rate for Payer: Health Net of AZ Commercial	$1.01
Rate for Payer: Health Net of AZ Medicare	$0.47
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Mercy Care Medicaid	$4.68
Rate for Payer: Self Pay Self Pay	$1.34
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.30

morphine 5 mg/ 1 mL Inj Sol PF [CQCH]

Facility

$1.84

Service Code	HCPCS J2270
Hospital Charge Code	108648889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Cash Price	$1.47
Rate for Payer: Self Pay Self Pay	$1.47

morphine 5 mg/ 1 mL Inj Sol PF [CQCH]

Facility

$1.84

Service Code	HCPCS J2270
Hospital Charge Code	108648889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.68
Rate for Payer: Aetna of AZ Commercial	$1.66
Rate for Payer: Aetna of AZ Medicare	$0.52
Rate for Payer: AHCCCS Medicaid	$4.68
Rate for Payer: Allwell Medicaid	$4.68
Rate for Payer: Allwell Medicare	$0.28
Rate for Payer: Amerigroup Medicare	$0.28
Rate for Payer: APIPA Medicare/Medicaid	$0.69
Rate for Payer: AZCH Complete Medicaid	$4.68
Rate for Payer: AZCH Complete Medicare	$0.28
Rate for Payer: Banner UC Health Medicaid	$4.68
Rate for Payer: Banner UC Health Medicare	$0.28
Rate for Payer: Bisbee Police All Plans	$0.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.25
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna of AZ Commercial	$1.20
Rate for Payer: Copperpoint Commercial	$0.46
Rate for Payer: Health Net of AZ Commercial	$1.10
Rate for Payer: Health Net of AZ Medicare	$0.52
Rate for Payer: Humana of AZ Medicare	$0.28
Rate for Payer: Mercy Care Medicaid	$4.68
Rate for Payer: Self Pay Self Pay	$1.47
Rate for Payer: TriWest Medicare	$0.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$1.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.33

MORPHOMETRIC ANALYSIS

Facility

$551.00

Service Code	CPT 88361
Hospital Charge Code	22545726
Hospital Revenue Code	310
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Aetna of AZ Medicare	$154.28
Rate for Payer: AHCCCS Medicaid	$211.16
Rate for Payer: Allwell Medicaid	$211.16
Rate for Payer: Allwell Medicare	$82.65
Rate for Payer: Amerigroup Medicare	$82.65
Rate for Payer: APIPA Medicare/Medicaid	$205.80
Rate for Payer: AZCH Complete Medicaid	$211.16
Rate for Payer: AZCH Complete Medicare	$82.65
Rate for Payer: Banner UC Health Medicaid	$211.16
Rate for Payer: Banner UC Health Medicare	$82.65
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.68
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Copperpoint Commercial	$136.37
Rate for Payer: Health Net of AZ Commercial	$330.60
Rate for Payer: Health Net of AZ Medicare	$154.28
Rate for Payer: Humana of AZ Medicare	$82.65
Rate for Payer: Mercy Care Medicaid	$211.16
Rate for Payer: Self Pay Self Pay	$440.80
Rate for Payer: TriWest Medicare	$82.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$321.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.18

MORPHOMETRIC ANALYSIS

Facility

$551.00

Service Code	CPT 88361
Hospital Charge Code	22545726
Hospital Revenue Code	310
Min. Negotiated Rate	$143.26
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Cash Price	$440.80
Rate for Payer: Self Pay Self Pay	$440.80

MRA Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74185
Hospital Charge Code	2214011
Hospital Revenue Code	610
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Aetna of AZ Medicare	$625.24
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$334.95
Rate for Payer: Amerigroup Medicare	$334.95
Rate for Payer: APIPA Medicare/Medicaid	$834.03
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$334.95
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$334.95
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,518.44
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cigna of AZ Commercial	$1,563.10
Rate for Payer: Copperpoint Commercial	$552.67
Rate for Payer: Health Net of AZ Commercial	$1,339.80
Rate for Payer: Health Net of AZ Medicare	$625.24
Rate for Payer: Humana of AZ Medicare	$334.95
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$1,786.40
Rate for Payer: TriWest Medicare	$334.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,301.84
Rate for Payer: UnitedHealth Group of AZ Medicare	$401.94

MRA Abdomen w/ Contrast

Facility

$2,233.00

Service Code	CPT 74185
Hospital Charge Code	2214011
Hospital Revenue Code	610
Min. Negotiated Rate	$580.58
Max. Negotiated Rate	$2,009.70
Rate for Payer: Aetna of AZ Commercial	$2,009.70
Rate for Payer: Bisbee Police All Plans	$580.58
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Self Pay Self Pay	$1,786.40

MRA Abdomen w/o Contrast

Facility

$1,985.00

Service Code	CPT 74185
Hospital Charge Code	2214014
Hospital Revenue Code	610
Min. Negotiated Rate	$516.10
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Self Pay Self Pay	$1,588.00

MRA Abdomen w/o Contrast

Facility

$1,985.00

Service Code	CPT 74185
Hospital Charge Code	2214014
Hospital Revenue Code	610
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna of AZ Commercial	$1,786.50
Rate for Payer: Aetna of AZ Medicare	$555.80
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$297.75
Rate for Payer: Amerigroup Medicare	$297.75
Rate for Payer: APIPA Medicare/Medicaid	$741.40
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$297.75
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$297.75
Rate for Payer: Bisbee Police All Plans	$516.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,349.80
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cigna of AZ Commercial	$1,389.50
Rate for Payer: Copperpoint Commercial	$491.29
Rate for Payer: Health Net of AZ Commercial	$1,191.00
Rate for Payer: Health Net of AZ Medicare	$555.80
Rate for Payer: Humana of AZ Medicare	$297.75
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$1,588.00
Rate for Payer: TriWest Medicare	$297.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,157.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$357.30

MRA Abdomen w/ + w/o Contrast

Facility

$2,481.00

Service Code	CPT 74185
Hospital Charge Code	1284639
Hospital Revenue Code	610
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Aetna of AZ Medicare	$694.68
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$372.15
Rate for Payer: Amerigroup Medicare	$372.15
Rate for Payer: APIPA Medicare/Medicaid	$926.65
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$372.15
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$372.15
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,687.08
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Cigna of AZ Commercial	$1,736.70
Rate for Payer: Copperpoint Commercial	$614.05
Rate for Payer: Health Net of AZ Commercial	$1,488.60
Rate for Payer: Health Net of AZ Medicare	$694.68
Rate for Payer: Humana of AZ Medicare	$372.15
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$1,984.80
Rate for Payer: TriWest Medicare	$372.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,446.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$446.58

MRA Abdomen w/ + w/o Contrast

Facility

$2,481.00

Service Code	CPT 74185
Hospital Charge Code	1284639
Hospital Revenue Code	610
Min. Negotiated Rate	$645.06
Max. Negotiated Rate	$2,232.90
Rate for Payer: Aetna of AZ Commercial	$2,232.90
Rate for Payer: Bisbee Police All Plans	$645.06
Rate for Payer: Cash Price	$1,984.80
Rate for Payer: Self Pay Self Pay	$1,984.80

MRA Brain w/o + w/ Contrast 70553

Facility

$2,363.00

Service Code	CPT 70553
Hospital Charge Code	22990106
Hospital Revenue Code	611
Min. Negotiated Rate	$614.38
Max. Negotiated Rate	$2,126.70
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Bisbee Police All Plans	$614.38
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Self Pay Self Pay	$1,890.40

MRA Brain w/o + w/ Contrast 70553

Facility

$2,363.00

Service Code	CPT 70553
Hospital Charge Code	22990106
Hospital Revenue Code	611
Min. Negotiated Rate	$354.45
Max. Negotiated Rate	$2,126.70
Rate for Payer: Banner UC Health Medicare	$354.45
Rate for Payer: Aetna of AZ Commercial	$2,126.70
Rate for Payer: Aetna of AZ Medicare	$661.64
Rate for Payer: AHCCCS Medicaid	$533.78
Rate for Payer: Allwell Medicaid	$533.78
Rate for Payer: Allwell Medicare	$354.45
Rate for Payer: Amerigroup Medicare	$354.45
Rate for Payer: APIPA Medicare/Medicaid	$882.58
Rate for Payer: AZCH Complete Medicaid	$533.78
Rate for Payer: AZCH Complete Medicare	$354.45
Rate for Payer: Banner UC Health Medicaid	$533.78
Rate for Payer: Bisbee Police All Plans	$614.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,606.84
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cigna of AZ Commercial	$1,654.10
Rate for Payer: Copperpoint Commercial	$584.84
Rate for Payer: Health Net of AZ Commercial	$1,417.80
Rate for Payer: Health Net of AZ Medicare	$661.64
Rate for Payer: Humana of AZ Medicare	$354.45
Rate for Payer: Mercy Care Medicaid	$533.78
Rate for Payer: Self Pay Self Pay	$1,890.40
Rate for Payer: TriWest Medicare	$354.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,377.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$425.34

MRA Head w/o Contrast 70544

Facility

$1,891.00

Service Code	CPT 70544
Hospital Charge Code	22986618
Hospital Revenue Code	615
Min. Negotiated Rate	$283.65
Max. Negotiated Rate	$1,701.90
Rate for Payer: Aetna of AZ Commercial	$1,701.90
Rate for Payer: Aetna of AZ Medicare	$529.48
Rate for Payer: AHCCCS Medicaid	$333.68
Rate for Payer: Allwell Medicaid	$333.68
Rate for Payer: Allwell Medicare	$283.65
Rate for Payer: Amerigroup Medicare	$283.65
Rate for Payer: APIPA Medicare/Medicaid	$706.29
Rate for Payer: AZCH Complete Medicaid	$333.68
Rate for Payer: AZCH Complete Medicare	$283.65
Rate for Payer: Banner UC Health Medicaid	$333.68
Rate for Payer: Banner UC Health Medicare	$283.65
Rate for Payer: Bisbee Police All Plans	$491.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,285.88
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cigna of AZ Commercial	$1,323.70
Rate for Payer: Copperpoint Commercial	$468.02
Rate for Payer: Health Net of AZ Commercial	$1,134.60
Rate for Payer: Health Net of AZ Medicare	$529.48
Rate for Payer: Humana of AZ Medicare	$283.65
Rate for Payer: Mercy Care Medicaid	$333.68
Rate for Payer: Self Pay Self Pay	$1,512.80
Rate for Payer: TriWest Medicare	$283.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,102.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$340.38

Know your out-of-pocket cost for care.

All Charges