Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

PIN KIT TACMOTION 1.5

Facility

$360.00

Hospital Charge Code	24129934
Hospital Revenue Code	270
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna of AZ Commercial	$324.00
Rate for Payer: Bisbee Police All Plans	$93.60
Rate for Payer: Cash Price	$288.00
Rate for Payer: Self Pay Self Pay	$288.00

PINK/RED INTRAOSSEOUS MODULE PEDS

Facility

$362.00

Hospital Charge Code	23149745
Hospital Revenue Code	272
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Cash Price	$289.60
Rate for Payer: Self Pay Self Pay	$289.60

PINK/RED INTRAOSSEOUS MODULE PEDS

Facility

$362.00

Hospital Charge Code	23149745
Hospital Revenue Code	272
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$325.80
Rate for Payer: Aetna of AZ Commercial	$325.80
Rate for Payer: Aetna of AZ Medicare	$101.36
Rate for Payer: Allwell Medicare	$54.30
Rate for Payer: Amerigroup Medicare	$54.30
Rate for Payer: APIPA Medicare/Medicaid	$135.21
Rate for Payer: AZCH Complete Medicare	$54.30
Rate for Payer: Banner UC Health Medicare	$54.30
Rate for Payer: Bisbee Police All Plans	$94.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.16
Rate for Payer: Cash Price	$289.60
Rate for Payer: Cigna of AZ Commercial	$253.40
Rate for Payer: Copperpoint Commercial	$89.60
Rate for Payer: Health Net of AZ Commercial	$217.20
Rate for Payer: Health Net of AZ Medicare	$101.36
Rate for Payer: Humana of AZ Medicare	$54.30
Rate for Payer: Self Pay Self Pay	$289.60
Rate for Payer: TriWest Medicare	$54.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.16

PINK/RED INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175712
Hospital Revenue Code	272
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Aetna of AZ Medicare	$84.56
Rate for Payer: Allwell Medicare	$45.30
Rate for Payer: Amerigroup Medicare	$45.30
Rate for Payer: APIPA Medicare/Medicaid	$112.80
Rate for Payer: AZCH Complete Medicare	$45.30
Rate for Payer: Banner UC Health Medicare	$45.30
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$205.36
Rate for Payer: Cash Price	$241.60
Rate for Payer: Cigna of AZ Commercial	$211.40
Rate for Payer: Copperpoint Commercial	$74.74
Rate for Payer: Health Net of AZ Commercial	$181.20
Rate for Payer: Health Net of AZ Medicare	$84.56
Rate for Payer: Humana of AZ Medicare	$45.30
Rate for Payer: Self Pay Self Pay	$241.60
Rate for Payer: TriWest Medicare	$45.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$176.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.36

PINK/RED INTUBATION MODULE PEDS

Facility

$302.00

Hospital Charge Code	23175712
Hospital Revenue Code	272
Min. Negotiated Rate	$78.52
Max. Negotiated Rate	$271.80
Rate for Payer: Aetna of AZ Commercial	$271.80
Rate for Payer: Bisbee Police All Plans	$78.52
Rate for Payer: Cash Price	$241.60
Rate for Payer: Self Pay Self Pay	$241.60

PINK/RED IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175705
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Aetna of AZ Medicare	$81.20
Rate for Payer: Allwell Medicare	$43.50
Rate for Payer: Amerigroup Medicare	$43.50
Rate for Payer: APIPA Medicare/Medicaid	$108.32
Rate for Payer: AZCH Complete Medicare	$43.50
Rate for Payer: Banner UC Health Medicare	$43.50
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$197.20
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cigna of AZ Commercial	$203.00
Rate for Payer: Copperpoint Commercial	$71.78
Rate for Payer: Health Net of AZ Commercial	$174.00
Rate for Payer: Health Net of AZ Medicare	$81.20
Rate for Payer: Humana of AZ Medicare	$43.50
Rate for Payer: Self Pay Self Pay	$232.00
Rate for Payer: TriWest Medicare	$43.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$169.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$52.20

PINK/RED IV DELIVERY MODULE PEDS

Facility

$290.00

Hospital Charge Code	23175705
Hospital Revenue Code	272
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna of AZ Commercial	$261.00
Rate for Payer: Bisbee Police All Plans	$75.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Self Pay Self Pay	$232.00

PINK/RED OXYGEN DELIVERY MODULE PEDS

Facility

$121.00

Hospital Charge Code	23175698
Hospital Revenue Code	272
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Aetna of AZ Medicare	$33.88
Rate for Payer: Allwell Medicare	$18.15
Rate for Payer: Amerigroup Medicare	$18.15
Rate for Payer: APIPA Medicare/Medicaid	$45.19
Rate for Payer: AZCH Complete Medicare	$18.15
Rate for Payer: Banner UC Health Medicare	$18.15
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$82.28
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cigna of AZ Commercial	$84.70
Rate for Payer: Copperpoint Commercial	$29.95
Rate for Payer: Health Net of AZ Commercial	$72.60
Rate for Payer: Health Net of AZ Medicare	$33.88
Rate for Payer: Humana of AZ Medicare	$18.15
Rate for Payer: Self Pay Self Pay	$96.80
Rate for Payer: TriWest Medicare	$18.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$70.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.78

PINK/RED OXYGEN DELIVERY MODULE PEDS

Facility

$121.00

Hospital Charge Code	23175698
Hospital Revenue Code	272
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$108.90
Rate for Payer: Aetna of AZ Commercial	$108.90
Rate for Payer: Bisbee Police All Plans	$31.46
Rate for Payer: Cash Price	$96.80
Rate for Payer: Self Pay Self Pay	$96.80

Pinworm Prep

Facility

$92.00

Service Code	CPT 87172
Hospital Charge Code	1725569
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: AHCCCS Medicaid	$4.27
Rate for Payer: Allwell Medicaid	$4.27
Rate for Payer: Allwell Medicare	$13.80
Rate for Payer: Amerigroup Medicare	$13.80
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicaid	$4.27
Rate for Payer: AZCH Complete Medicare	$13.80
Rate for Payer: Banner UC Health Medicaid	$4.27
Rate for Payer: Banner UC Health Medicare	$13.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$13.80
Rate for Payer: Mercy Care Medicaid	$4.27
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$13.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

Pinworm Prep

Facility

$88.00

Service Code	CPT 87172
Hospital Charge Code	633912
Hospital Revenue Code	306
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Cash Price	$70.40
Rate for Payer: Self Pay Self Pay	$70.40

Pinworm Prep

Facility

$88.00

Service Code	CPT 87172
Hospital Charge Code	633912
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of AZ Commercial	$79.20
Rate for Payer: Aetna of AZ Medicare	$24.64
Rate for Payer: AHCCCS Medicaid	$4.27
Rate for Payer: Allwell Medicaid	$4.27
Rate for Payer: Allwell Medicare	$13.20
Rate for Payer: Amerigroup Medicare	$13.20
Rate for Payer: APIPA Medicare/Medicaid	$32.87
Rate for Payer: AZCH Complete Medicaid	$4.27
Rate for Payer: AZCH Complete Medicare	$13.20
Rate for Payer: Banner UC Health Medicaid	$4.27
Rate for Payer: Banner UC Health Medicare	$13.20
Rate for Payer: Bisbee Police All Plans	$22.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$59.84
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cigna of AZ Commercial	$57.20
Rate for Payer: Copperpoint Commercial	$21.78
Rate for Payer: Health Net of AZ Commercial	$52.80
Rate for Payer: Health Net of AZ Medicare	$24.64
Rate for Payer: Humana of AZ Medicare	$13.20
Rate for Payer: Mercy Care Medicaid	$4.27
Rate for Payer: Self Pay Self Pay	$70.40
Rate for Payer: TriWest Medicare	$13.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$51.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.84

Pinworm Prep

Facility

$92.00

Service Code	CPT 87172
Hospital Charge Code	1725569
Hospital Revenue Code	306
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

piperacillin-tazobactam 2.25 gm IV Inj [CQCH]

Facility

$3.90

Service Code	HCPCS J2543
Hospital Charge Code	105970066
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna of AZ Commercial	$3.51
Rate for Payer: Bisbee Police All Plans	$1.01
Rate for Payer: Cash Price	$3.12
Rate for Payer: Self Pay Self Pay	$3.12

piperacillin-tazobactam 2.25 gm IV Inj [CQCH]

Facility

$3.90

Service Code	HCPCS J2543
Hospital Charge Code	105970066
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna of AZ Commercial	$3.51
Rate for Payer: Aetna of AZ Medicare	$1.09
Rate for Payer: AHCCCS Medicaid	$2.90
Rate for Payer: Allwell Medicaid	$2.90
Rate for Payer: Allwell Medicare	$0.59
Rate for Payer: Amerigroup Medicare	$0.59
Rate for Payer: APIPA Medicare/Medicaid	$1.46
Rate for Payer: AZCH Complete Medicaid	$2.90
Rate for Payer: AZCH Complete Medicare	$0.59
Rate for Payer: Banner UC Health Medicaid	$2.90
Rate for Payer: Banner UC Health Medicare	$0.59
Rate for Payer: Bisbee Police All Plans	$1.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.65
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cigna of AZ Commercial	$2.54
Rate for Payer: Copperpoint Commercial	$0.97
Rate for Payer: Health Net of AZ Commercial	$2.34
Rate for Payer: Health Net of AZ Medicare	$1.09
Rate for Payer: Humana of AZ Medicare	$0.59
Rate for Payer: Mercy Care Medicaid	$2.90
Rate for Payer: Self Pay Self Pay	$3.12
Rate for Payer: TriWest Medicare	$0.59
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.70

piperacillin-tazobactam 3.375 gm IV Inj [CQCH]

Facility

$5.30

Service Code	HCPCS J2543
Hospital Charge Code	105970909
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$4.77
Rate for Payer: Aetna of AZ Commercial	$4.77
Rate for Payer: Bisbee Police All Plans	$1.38
Rate for Payer: Cash Price	$4.24
Rate for Payer: Self Pay Self Pay	$4.24

piperacillin-tazobactam 3.375 gm IV Inj [CQCH]

Facility

$5.30

Service Code	HCPCS J2543
Hospital Charge Code	105970909
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$4.77
Rate for Payer: Aetna of AZ Commercial	$4.77
Rate for Payer: Aetna of AZ Medicare	$1.48
Rate for Payer: AHCCCS Medicaid	$2.90
Rate for Payer: Allwell Medicaid	$2.90
Rate for Payer: Allwell Medicare	$0.80
Rate for Payer: Amerigroup Medicare	$0.80
Rate for Payer: APIPA Medicare/Medicaid	$1.98
Rate for Payer: AZCH Complete Medicaid	$2.90
Rate for Payer: AZCH Complete Medicare	$0.80
Rate for Payer: Banner UC Health Medicaid	$2.90
Rate for Payer: Banner UC Health Medicare	$0.80
Rate for Payer: Bisbee Police All Plans	$1.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3.60
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cigna of AZ Commercial	$3.44
Rate for Payer: Copperpoint Commercial	$1.31
Rate for Payer: Health Net of AZ Commercial	$3.18
Rate for Payer: Health Net of AZ Medicare	$1.48
Rate for Payer: Humana of AZ Medicare	$0.80
Rate for Payer: Mercy Care Medicaid	$2.90
Rate for Payer: Self Pay Self Pay	$4.24
Rate for Payer: TriWest Medicare	$0.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$3.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.95

piperacillin-tazobactam 4.5 gm rec [CQCH]

Facility

$8.25

Service Code	HCPCS J2543
Hospital Charge Code	112390998
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna of AZ Commercial	$7.42
Rate for Payer: Bisbee Police All Plans	$2.14
Rate for Payer: Cash Price	$6.60
Rate for Payer: Self Pay Self Pay	$6.60

piperacillin-tazobactam 4.5 gm rec [CQCH]

Facility

$8.25

Service Code	HCPCS J2543
Hospital Charge Code	112390998
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna of AZ Commercial	$7.42
Rate for Payer: Aetna of AZ Medicare	$2.31
Rate for Payer: AHCCCS Medicaid	$2.90
Rate for Payer: Allwell Medicaid	$2.90
Rate for Payer: Allwell Medicare	$1.24
Rate for Payer: Amerigroup Medicare	$1.24
Rate for Payer: APIPA Medicare/Medicaid	$3.08
Rate for Payer: AZCH Complete Medicaid	$2.90
Rate for Payer: AZCH Complete Medicare	$1.24
Rate for Payer: Banner UC Health Medicaid	$2.90
Rate for Payer: Banner UC Health Medicare	$1.24
Rate for Payer: Bisbee Police All Plans	$2.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5.61
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cigna of AZ Commercial	$5.36
Rate for Payer: Copperpoint Commercial	$2.04
Rate for Payer: Health Net of AZ Commercial	$4.95
Rate for Payer: Health Net of AZ Medicare	$2.31
Rate for Payer: Humana of AZ Medicare	$1.24
Rate for Payer: Mercy Care Medicaid	$2.90
Rate for Payer: Self Pay Self Pay	$6.60
Rate for Payer: TriWest Medicare	$1.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$4.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.48

PKS CUTTING FORCEP 5MM/33CM

Facility

$1,557.00

Hospital Charge Code	22562751
Hospital Revenue Code	272
Min. Negotiated Rate	$233.55
Max. Negotiated Rate	$1,401.30
Rate for Payer: Aetna of AZ Commercial	$1,401.30
Rate for Payer: Aetna of AZ Medicare	$435.96
Rate for Payer: Allwell Medicare	$233.55
Rate for Payer: Amerigroup Medicare	$233.55
Rate for Payer: APIPA Medicare/Medicaid	$581.54
Rate for Payer: AZCH Complete Medicare	$233.55
Rate for Payer: Banner UC Health Medicare	$233.55
Rate for Payer: Bisbee Police All Plans	$404.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,058.76
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Cigna of AZ Commercial	$1,089.90
Rate for Payer: Copperpoint Commercial	$385.36
Rate for Payer: Health Net of AZ Commercial	$934.20
Rate for Payer: Health Net of AZ Medicare	$435.96
Rate for Payer: Humana of AZ Medicare	$233.55
Rate for Payer: Self Pay Self Pay	$1,245.60
Rate for Payer: TriWest Medicare	$233.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$907.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$280.26

PKS CUTTING FORCEP 5MM/33CM

Facility

$1,557.00

Hospital Charge Code	22562751
Hospital Revenue Code	272
Min. Negotiated Rate	$404.82
Max. Negotiated Rate	$1,401.30
Rate for Payer: Aetna of AZ Commercial	$1,401.30
Rate for Payer: Bisbee Police All Plans	$404.82
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Self Pay Self Pay	$1,245.60

PKU Newborn

Facility

$135.00

Service Code	CPT 84030
Hospital Charge Code	1206897
Hospital Revenue Code	301
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Cash Price	$108.00
Rate for Payer: Self Pay Self Pay	$108.00

PKU Newborn

Facility

$135.00

Service Code	CPT 84030
Hospital Charge Code	1206897
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna of AZ Commercial	$121.50
Rate for Payer: Aetna of AZ Medicare	$37.80
Rate for Payer: AHCCCS Medicaid	$5.50
Rate for Payer: Allwell Medicaid	$5.50
Rate for Payer: Allwell Medicare	$20.25
Rate for Payer: Amerigroup Medicare	$20.25
Rate for Payer: APIPA Medicare/Medicaid	$50.42
Rate for Payer: AZCH Complete Medicaid	$5.50
Rate for Payer: AZCH Complete Medicare	$20.25
Rate for Payer: Banner UC Health Medicaid	$5.50
Rate for Payer: Banner UC Health Medicare	$20.25
Rate for Payer: Bisbee Police All Plans	$35.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$91.80
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna of AZ Commercial	$87.75
Rate for Payer: Copperpoint Commercial	$33.41
Rate for Payer: Health Net of AZ Commercial	$81.00
Rate for Payer: Health Net of AZ Medicare	$37.80
Rate for Payer: Humana of AZ Medicare	$20.25
Rate for Payer: Mercy Care Medicaid	$5.50
Rate for Payer: Self Pay Self Pay	$108.00
Rate for Payer: TriWest Medicare	$20.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$78.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.30

PKU- Newborn

Facility

$142.00

Service Code	CPT 84030
Hospital Charge Code	22350384
Hospital Revenue Code	301
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Cash Price	$113.60
Rate for Payer: Self Pay Self Pay	$113.60

PKU- Newborn

Facility

$142.00

Service Code	CPT 84030
Hospital Charge Code	22350384
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$127.80
Rate for Payer: Aetna of AZ Commercial	$127.80
Rate for Payer: Aetna of AZ Medicare	$39.76
Rate for Payer: AHCCCS Medicaid	$5.50
Rate for Payer: Allwell Medicaid	$5.50
Rate for Payer: Allwell Medicare	$21.30
Rate for Payer: Amerigroup Medicare	$21.30
Rate for Payer: APIPA Medicare/Medicaid	$53.04
Rate for Payer: AZCH Complete Medicaid	$5.50
Rate for Payer: AZCH Complete Medicare	$21.30
Rate for Payer: Banner UC Health Medicaid	$5.50
Rate for Payer: Banner UC Health Medicare	$21.30
Rate for Payer: Bisbee Police All Plans	$36.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$96.56
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cigna of AZ Commercial	$92.30
Rate for Payer: Copperpoint Commercial	$35.14
Rate for Payer: Health Net of AZ Commercial	$85.20
Rate for Payer: Health Net of AZ Medicare	$39.76
Rate for Payer: Humana of AZ Medicare	$21.30
Rate for Payer: Mercy Care Medicaid	$5.50
Rate for Payer: Self Pay Self Pay	$113.60
Rate for Payer: TriWest Medicare	$21.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$82.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$25.56

Know your out-of-pocket cost for care.

All Charges