Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

rifaximin 200 mg Tab [CQCH]

Facility

$20.78

Service Code	NDC 65649030103
Hospital Charge Code	105939447
Hospital Revenue Code	251
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna of AZ Commercial	$18.70
Rate for Payer: Aetna of AZ Medicare	$5.82
Rate for Payer: Allwell Medicare	$3.12
Rate for Payer: Amerigroup Medicare	$3.12
Rate for Payer: APIPA Medicare/Medicaid	$7.76
Rate for Payer: AZCH Complete Medicare	$3.12
Rate for Payer: Banner UC Health Medicare	$3.12
Rate for Payer: Bisbee Police All Plans	$5.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$14.13
Rate for Payer: Cash Price	$16.62
Rate for Payer: Cigna of AZ Commercial	$13.51
Rate for Payer: Copperpoint Commercial	$5.14
Rate for Payer: Health Net of AZ Commercial	$12.47
Rate for Payer: Health Net of AZ Medicare	$5.82
Rate for Payer: Humana of AZ Medicare	$3.12
Rate for Payer: Self Pay Self Pay	$16.62
Rate for Payer: TriWest Medicare	$3.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$12.11
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.74

rifaximin 200 mg Tab [CQCH]

Facility

$20.78

Service Code	NDC 65649030103
Hospital Charge Code	105939447
Hospital Revenue Code	251
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna of AZ Commercial	$18.70
Rate for Payer: Bisbee Police All Plans	$5.40
Rate for Payer: Cash Price	$16.62
Rate for Payer: Self Pay Self Pay	$16.62

RIGID SINGLE USE STYLET MEDIUM

Facility

$57.00

Hospital Charge Code	27728098
Hospital Revenue Code	270
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Aetna of AZ Medicare	$15.96
Rate for Payer: Allwell Medicare	$8.55
Rate for Payer: Amerigroup Medicare	$8.55
Rate for Payer: APIPA Medicare/Medicaid	$21.29
Rate for Payer: AZCH Complete Medicare	$8.55
Rate for Payer: Banner UC Health Medicare	$8.55
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$38.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cigna of AZ Commercial	$39.90
Rate for Payer: Copperpoint Commercial	$14.11
Rate for Payer: Health Net of AZ Commercial	$34.20
Rate for Payer: Health Net of AZ Medicare	$15.96
Rate for Payer: Humana of AZ Medicare	$8.55
Rate for Payer: Self Pay Self Pay	$45.60
Rate for Payer: TriWest Medicare	$8.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.26

RIGID SINGLE USE STYLET MEDIUM

Facility

$57.00

Hospital Charge Code	27728098
Hospital Revenue Code	270
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$51.30
Rate for Payer: Aetna of AZ Commercial	$51.30
Rate for Payer: Bisbee Police All Plans	$14.82
Rate for Payer: Cash Price	$45.60
Rate for Payer: Self Pay Self Pay	$45.60

RIGID SINGLE USE STYLET SMALL

Facility

$33.00

Hospital Charge Code	27728092
Hospital Revenue Code	270
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Cash Price	$26.40
Rate for Payer: Self Pay Self Pay	$26.40

RIGID SINGLE USE STYLET SMALL

Facility

$33.00

Hospital Charge Code	27728092
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$29.70
Rate for Payer: Aetna of AZ Commercial	$29.70
Rate for Payer: Aetna of AZ Medicare	$9.24
Rate for Payer: Allwell Medicare	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: APIPA Medicare/Medicaid	$12.33
Rate for Payer: AZCH Complete Medicare	$4.95
Rate for Payer: Banner UC Health Medicare	$4.95
Rate for Payer: Bisbee Police All Plans	$8.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$22.44
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cigna of AZ Commercial	$23.10
Rate for Payer: Copperpoint Commercial	$8.17
Rate for Payer: Health Net of AZ Commercial	$19.80
Rate for Payer: Health Net of AZ Medicare	$9.24
Rate for Payer: Humana of AZ Medicare	$4.95
Rate for Payer: Self Pay Self Pay	$26.40
Rate for Payer: TriWest Medicare	$4.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$19.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.94

risankizumab rzaa 60 mg/mL Sol[CQCH]

Facility

$921.80

Service Code	HCPCS J2327
Hospital Charge Code	222641743
Hospital Revenue Code	250
Min. Negotiated Rate	$239.67
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna of AZ Commercial	$829.62
Rate for Payer: Bisbee Police All Plans	$239.67
Rate for Payer: Cash Price	$737.44
Rate for Payer: Self Pay Self Pay	$737.44

risankizumab rzaa 60 mg/mL Sol[CQCH]

Facility

$921.80

Service Code	HCPCS J2327
Hospital Charge Code	222641743
Hospital Revenue Code	250
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna of AZ Commercial	$829.62
Rate for Payer: Aetna of AZ Medicare	$258.10
Rate for Payer: AHCCCS Medicaid	$25.30
Rate for Payer: Allwell Medicaid	$25.30
Rate for Payer: Allwell Medicare	$138.27
Rate for Payer: Amerigroup Medicare	$138.27
Rate for Payer: APIPA Medicare/Medicaid	$344.29
Rate for Payer: AZCH Complete Medicaid	$25.30
Rate for Payer: AZCH Complete Medicare	$138.27
Rate for Payer: Banner UC Health Medicaid	$25.30
Rate for Payer: Banner UC Health Medicare	$138.27
Rate for Payer: Bisbee Police All Plans	$239.67
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$626.82
Rate for Payer: Cash Price	$737.44
Rate for Payer: Cash Price	$737.44
Rate for Payer: Cigna of AZ Commercial	$599.17
Rate for Payer: Copperpoint Commercial	$228.15
Rate for Payer: Health Net of AZ Commercial	$553.08
Rate for Payer: Health Net of AZ Medicare	$258.10
Rate for Payer: Humana of AZ Medicare	$138.27
Rate for Payer: Mercy Care Medicaid	$25.30
Rate for Payer: Self Pay Self Pay	$737.44
Rate for Payer: TriWest Medicare	$138.27
Rate for Payer: UnitedHealth Group of AZ Commercial	$537.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$165.92

risperiDONE 0.5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 904635861
Hospital Charge Code	105939512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.07
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.14
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.13
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.12
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.16
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.12
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

risperiDONE 0.5 mg Tab [CQCH]

Facility

$0.20

Service Code	NDC 904635861
Hospital Charge Code	105939512
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.18
Rate for Payer: Aetna of AZ Commercial	$0.18
Rate for Payer: Bisbee Police All Plans	$0.05
Rate for Payer: Cash Price	$0.16
Rate for Payer: Self Pay Self Pay	$0.16

rivaroxaban 10 mg Tab [CQCH]

Facility

$12.04

Service Code	NDC 50458058010
Hospital Charge Code	105939709
Hospital Revenue Code	251
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of AZ Commercial	$10.84
Rate for Payer: Bisbee Police All Plans	$3.13
Rate for Payer: Cash Price	$9.63
Rate for Payer: Self Pay Self Pay	$9.63

rivaroxaban 10 mg Tab [CQCH]

Facility

$12.04

Service Code	NDC 50458058010
Hospital Charge Code	105939709
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna of AZ Commercial	$10.84
Rate for Payer: Aetna of AZ Medicare	$3.37
Rate for Payer: Allwell Medicare	$1.81
Rate for Payer: Amerigroup Medicare	$1.81
Rate for Payer: APIPA Medicare/Medicaid	$4.50
Rate for Payer: AZCH Complete Medicare	$1.81
Rate for Payer: Banner UC Health Medicare	$1.81
Rate for Payer: Bisbee Police All Plans	$3.13
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.19
Rate for Payer: Cash Price	$9.63
Rate for Payer: Cigna of AZ Commercial	$7.83
Rate for Payer: Copperpoint Commercial	$2.98
Rate for Payer: Health Net of AZ Commercial	$7.22
Rate for Payer: Health Net of AZ Medicare	$3.37
Rate for Payer: Humana of AZ Medicare	$1.81
Rate for Payer: Self Pay Self Pay	$9.63
Rate for Payer: TriWest Medicare	$1.81
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.17

rivaroxaban 15 mg Tab [CQCH]

Facility

$11.81

Service Code	NDC 50458057810
Hospital Charge Code	105939642
Hospital Revenue Code	251
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of AZ Commercial	$10.63
Rate for Payer: Aetna of AZ Medicare	$3.31
Rate for Payer: Allwell Medicare	$1.77
Rate for Payer: Amerigroup Medicare	$1.77
Rate for Payer: APIPA Medicare/Medicaid	$4.41
Rate for Payer: AZCH Complete Medicare	$1.77
Rate for Payer: Banner UC Health Medicare	$1.77
Rate for Payer: Bisbee Police All Plans	$3.07
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.03
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cigna of AZ Commercial	$7.68
Rate for Payer: Copperpoint Commercial	$2.92
Rate for Payer: Health Net of AZ Commercial	$7.09
Rate for Payer: Health Net of AZ Medicare	$3.31
Rate for Payer: Humana of AZ Medicare	$1.77
Rate for Payer: Self Pay Self Pay	$9.45
Rate for Payer: TriWest Medicare	$1.77
Rate for Payer: UnitedHealth Group of AZ Commercial	$6.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.13

rivaroxaban 15 mg Tab [CQCH]

Facility

$11.81

Service Code	NDC 50458057810
Hospital Charge Code	105939642
Hospital Revenue Code	251
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of AZ Commercial	$10.63
Rate for Payer: Bisbee Police All Plans	$3.07
Rate for Payer: Cash Price	$9.45
Rate for Payer: Self Pay Self Pay	$9.45

.RMSF, IgG, IFA LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	1285666
Hospital Revenue Code	302
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Cash Price	$190.40
Rate for Payer: Self Pay Self Pay	$190.40

.RMSF, IgG, IFA LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	1285666
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Aetna of AZ Medicare	$66.64
Rate for Payer: AHCCCS Medicaid	$19.35
Rate for Payer: Allwell Medicaid	$19.35
Rate for Payer: Allwell Medicare	$35.70
Rate for Payer: Amerigroup Medicare	$35.70
Rate for Payer: APIPA Medicare/Medicaid	$88.89
Rate for Payer: AZCH Complete Medicaid	$19.35
Rate for Payer: AZCH Complete Medicare	$35.70
Rate for Payer: Banner UC Health Medicaid	$19.35
Rate for Payer: Banner UC Health Medicare	$35.70
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.84
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$154.70
Rate for Payer: Copperpoint Commercial	$58.90
Rate for Payer: Health Net of AZ Commercial	$142.80
Rate for Payer: Health Net of AZ Medicare	$66.64
Rate for Payer: Humana of AZ Medicare	$35.70
Rate for Payer: Mercy Care Medicaid	$19.35
Rate for Payer: Self Pay Self Pay	$190.40
Rate for Payer: TriWest Medicare	$35.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.84

RNA, PCR (NonGraph) rfx/Geno LC

Facility

$719.00

Service Code	CPT 87522
Hospital Charge Code	22311205
Hospital Revenue Code	306
Min. Negotiated Rate	$186.94
Max. Negotiated Rate	$647.10
Rate for Payer: Aetna of AZ Commercial	$647.10
Rate for Payer: Bisbee Police All Plans	$186.94
Rate for Payer: Cash Price	$575.20
Rate for Payer: Self Pay Self Pay	$575.20

RNA, PCR (NonGraph) rfx/Geno LC

Facility

$719.00

Service Code	CPT 87522
Hospital Charge Code	22311205
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$647.10
Rate for Payer: Aetna of AZ Commercial	$647.10
Rate for Payer: Aetna of AZ Medicare	$201.32
Rate for Payer: AHCCCS Medicaid	$42.84
Rate for Payer: Allwell Medicaid	$42.84
Rate for Payer: Allwell Medicare	$107.85
Rate for Payer: Amerigroup Medicare	$107.85
Rate for Payer: APIPA Medicare/Medicaid	$268.55
Rate for Payer: AZCH Complete Medicaid	$42.84
Rate for Payer: AZCH Complete Medicare	$107.85
Rate for Payer: Banner UC Health Medicaid	$42.84
Rate for Payer: Banner UC Health Medicare	$107.85
Rate for Payer: Bisbee Police All Plans	$186.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$488.92
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cigna of AZ Commercial	$467.35
Rate for Payer: Copperpoint Commercial	$177.95
Rate for Payer: Health Net of AZ Commercial	$431.40
Rate for Payer: Health Net of AZ Medicare	$201.32
Rate for Payer: Humana of AZ Medicare	$107.85
Rate for Payer: Mercy Care Medicaid	$42.84
Rate for Payer: Self Pay Self Pay	$575.20
Rate for Payer: TriWest Medicare	$107.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$419.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.42

RNA Real Time PCR (Non-Graph) LC

Facility

$1,058.00

Service Code	CPT 87536
Hospital Charge Code	6781926
Hospital Revenue Code	302
Min. Negotiated Rate	$275.08
Max. Negotiated Rate	$952.20
Rate for Payer: Aetna of AZ Commercial	$952.20
Rate for Payer: Bisbee Police All Plans	$275.08
Rate for Payer: Cash Price	$846.40
Rate for Payer: Self Pay Self Pay	$846.40

RNA Real Time PCR (Non-Graph) LC

Facility

$1,058.00

Service Code	CPT 87536
Hospital Charge Code	6781926
Hospital Revenue Code	302
Min. Negotiated Rate	$85.10
Max. Negotiated Rate	$952.20
Rate for Payer: Aetna of AZ Commercial	$952.20
Rate for Payer: Aetna of AZ Medicare	$296.24
Rate for Payer: AHCCCS Medicaid	$85.10
Rate for Payer: Allwell Medicaid	$85.10
Rate for Payer: Allwell Medicare	$158.70
Rate for Payer: Amerigroup Medicare	$158.70
Rate for Payer: APIPA Medicare/Medicaid	$395.16
Rate for Payer: AZCH Complete Medicaid	$85.10
Rate for Payer: AZCH Complete Medicare	$158.70
Rate for Payer: Banner UC Health Medicaid	$85.10
Rate for Payer: Banner UC Health Medicare	$158.70
Rate for Payer: Bisbee Police All Plans	$275.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$719.44
Rate for Payer: Cash Price	$846.40
Rate for Payer: Cash Price	$846.40
Rate for Payer: Cigna of AZ Commercial	$687.70
Rate for Payer: Copperpoint Commercial	$261.86
Rate for Payer: Health Net of AZ Commercial	$634.80
Rate for Payer: Health Net of AZ Medicare	$296.24
Rate for Payer: Humana of AZ Medicare	$158.70
Rate for Payer: Mercy Care Medicaid	$85.10
Rate for Payer: Self Pay Self Pay	$846.40
Rate for Payer: TriWest Medicare	$158.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$616.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$190.44

Robotic colpopexy

Facility

$5,050.00

Service Code	CPT 57425
Hospital Charge Code	27281899
Hospital Revenue Code	360
Min. Negotiated Rate	$757.50
Max. Negotiated Rate	$12,916.10
Rate for Payer: Aetna of AZ Commercial	$4,545.00
Rate for Payer: Aetna of AZ Medicare	$1,414.00
Rate for Payer: AHCCCS Medicaid	$12,916.10
Rate for Payer: Allwell Medicaid	$12,916.10
Rate for Payer: Allwell Medicare	$757.50
Rate for Payer: Amerigroup Medicare	$757.50
Rate for Payer: APIPA Medicare/Medicaid	$1,886.18
Rate for Payer: AZCH Complete Medicaid	$12,916.10
Rate for Payer: AZCH Complete Medicare	$757.50
Rate for Payer: Banner UC Health Medicaid	$12,916.10
Rate for Payer: Banner UC Health Medicare	$757.50
Rate for Payer: Bisbee Police All Plans	$1,313.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,434.00
Rate for Payer: Cash Price	$4,040.00
Rate for Payer: Cash Price	$4,040.00
Rate for Payer: Cigna of AZ Commercial	$2,525.00
Rate for Payer: Copperpoint Commercial	$1,249.88
Rate for Payer: Health Net of AZ Commercial	$3,030.00
Rate for Payer: Health Net of AZ Medicare	$1,414.00
Rate for Payer: Humana of AZ Medicare	$757.50
Rate for Payer: Mercy Care Medicaid	$12,916.10
Rate for Payer: Self Pay Self Pay	$4,040.00
Rate for Payer: TriWest Medicare	$757.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$909.00

Robotic colpopexy

Facility

$5,050.00

Service Code	CPT 57425
Hospital Charge Code	27281899
Hospital Revenue Code	360
Min. Negotiated Rate	$1,313.00
Max. Negotiated Rate	$4,545.00
Rate for Payer: Aetna of AZ Commercial	$4,545.00
Rate for Payer: Bisbee Police All Plans	$1,313.00
Rate for Payer: Cash Price	$4,040.00
Rate for Payer: Self Pay Self Pay	$4,040.00

Rocky Mtn Spotted Fever, IgM LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	1285661
Hospital Revenue Code	302
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Cash Price	$190.40
Rate for Payer: Self Pay Self Pay	$190.40

Rocky Mtn Spotted Fever, IgM LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	1285661
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Aetna of AZ Medicare	$66.64
Rate for Payer: AHCCCS Medicaid	$19.35
Rate for Payer: Allwell Medicaid	$19.35
Rate for Payer: Allwell Medicare	$35.70
Rate for Payer: Amerigroup Medicare	$35.70
Rate for Payer: APIPA Medicare/Medicaid	$88.89
Rate for Payer: AZCH Complete Medicaid	$19.35
Rate for Payer: AZCH Complete Medicare	$35.70
Rate for Payer: Banner UC Health Medicaid	$19.35
Rate for Payer: Banner UC Health Medicare	$35.70
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.84
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cigna of AZ Commercial	$154.70
Rate for Payer: Copperpoint Commercial	$58.90
Rate for Payer: Health Net of AZ Commercial	$142.80
Rate for Payer: Health Net of AZ Medicare	$66.64
Rate for Payer: Humana of AZ Medicare	$35.70
Rate for Payer: Mercy Care Medicaid	$19.35
Rate for Payer: Self Pay Self Pay	$190.40
Rate for Payer: TriWest Medicare	$35.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.75
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.84

Rocky Mtn Spotted Fev, IgG, Qn LC

Facility

$238.00

Service Code	CPT 86757
Hospital Charge Code	1285665
Hospital Revenue Code	302
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna of AZ Commercial	$214.20
Rate for Payer: Bisbee Police All Plans	$61.88
Rate for Payer: Cash Price	$190.40
Rate for Payer: Self Pay Self Pay	$190.40

Know your out-of-pocket cost for care.

All Charges