Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

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

rocuronium 100 mg/10 mL inj Sol [CQCH]

Facility

$0.35

Service Code	NDC 55150022610
Hospital Charge Code	108079385
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.28
Rate for Payer: Self Pay Self Pay	$0.28

rocuronium 100 mg/10 mL inj Sol [CQCH]

Facility

$0.35

Service Code	NDC 55150022610
Hospital Charge Code	108079385
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of AZ Commercial	$0.32
Rate for Payer: Aetna of AZ Medicare	$0.10
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.13
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	$0.24
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of AZ Commercial	$0.23
Rate for Payer: Copperpoint Commercial	$0.09
Rate for Payer: Health Net of AZ Commercial	$0.21
Rate for Payer: Health Net of AZ Medicare	$0.10
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.28
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.20
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

romiPLOStim 125 mcg REC[CQCH]

Facility

$1,032.35

Service Code	HCPCS J2796
Hospital Charge Code	189610323
Hospital Revenue Code	251
Min. Negotiated Rate	$145.98
Max. Negotiated Rate	$929.12
Rate for Payer: Aetna of AZ Commercial	$929.12
Rate for Payer: Aetna of AZ Medicare	$289.06
Rate for Payer: AHCCCS Medicaid	$145.98
Rate for Payer: Allwell Medicaid	$145.98
Rate for Payer: Allwell Medicare	$154.85
Rate for Payer: Amerigroup Medicare	$154.85
Rate for Payer: APIPA Medicare/Medicaid	$385.58
Rate for Payer: AZCH Complete Medicaid	$145.98
Rate for Payer: AZCH Complete Medicare	$154.85
Rate for Payer: Banner UC Health Medicaid	$145.98
Rate for Payer: Banner UC Health Medicare	$154.85
Rate for Payer: Bisbee Police All Plans	$268.41
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$702.00
Rate for Payer: Cash Price	$825.88
Rate for Payer: Cash Price	$825.88
Rate for Payer: Cigna of AZ Commercial	$671.03
Rate for Payer: Copperpoint Commercial	$255.51
Rate for Payer: Health Net of AZ Commercial	$619.41
Rate for Payer: Health Net of AZ Medicare	$289.06
Rate for Payer: Humana of AZ Medicare	$154.85
Rate for Payer: Mercy Care Medicaid	$145.98
Rate for Payer: Self Pay Self Pay	$825.88
Rate for Payer: TriWest Medicare	$154.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$601.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$185.82

romiPLOStim 125 mcg REC[CQCH]

Facility

$1,032.35

Service Code	HCPCS J2796
Hospital Charge Code	189610323
Hospital Revenue Code	251
Min. Negotiated Rate	$268.41
Max. Negotiated Rate	$929.12
Rate for Payer: Aetna of AZ Commercial	$929.12
Rate for Payer: Bisbee Police All Plans	$268.41
Rate for Payer: Cash Price	$825.88
Rate for Payer: Self Pay Self Pay	$825.88

romiPLOStim 250 mcg REC[CQCH]

Facility

$2,064.68

Service Code	HCPCS J2796
Hospital Charge Code	189307178
Hospital Revenue Code	251
Min. Negotiated Rate	$536.82
Max. Negotiated Rate	$1,858.21
Rate for Payer: Aetna of AZ Commercial	$1,858.21
Rate for Payer: Bisbee Police All Plans	$536.82
Rate for Payer: Cash Price	$1,651.74
Rate for Payer: Self Pay Self Pay	$1,651.74

romiPLOStim 250 mcg REC[CQCH]

Facility

$2,064.68

Service Code	HCPCS J2796
Hospital Charge Code	189307178
Hospital Revenue Code	251
Min. Negotiated Rate	$145.98
Max. Negotiated Rate	$1,858.21
Rate for Payer: Aetna of AZ Commercial	$1,858.21
Rate for Payer: Aetna of AZ Medicare	$578.11
Rate for Payer: AHCCCS Medicaid	$145.98
Rate for Payer: Allwell Medicaid	$145.98
Rate for Payer: Allwell Medicare	$309.70
Rate for Payer: Amerigroup Medicare	$309.70
Rate for Payer: APIPA Medicare/Medicaid	$771.16
Rate for Payer: AZCH Complete Medicaid	$145.98
Rate for Payer: AZCH Complete Medicare	$309.70
Rate for Payer: Banner UC Health Medicaid	$145.98
Rate for Payer: Banner UC Health Medicare	$309.70
Rate for Payer: Bisbee Police All Plans	$536.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,403.98
Rate for Payer: Cash Price	$1,651.74
Rate for Payer: Cash Price	$1,651.74
Rate for Payer: Cigna of AZ Commercial	$1,342.04
Rate for Payer: Copperpoint Commercial	$511.01
Rate for Payer: Health Net of AZ Commercial	$1,238.81
Rate for Payer: Health Net of AZ Medicare	$578.11
Rate for Payer: Humana of AZ Medicare	$309.70
Rate for Payer: Mercy Care Medicaid	$145.98
Rate for Payer: Self Pay Self Pay	$1,651.74
Rate for Payer: TriWest Medicare	$309.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,203.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$371.64

ROOM/BED: Extended Recovery

Facility

$53.00

Hospital Charge Code	2091602
Hospital Revenue Code	710
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Cash Price	$42.40
Rate for Payer: Self Pay Self Pay	$42.40

ROOM/BED: Extended Recovery

Facility

$53.00

Hospital Charge Code	2091602
Hospital Revenue Code	710
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna of AZ Commercial	$47.70
Rate for Payer: Aetna of AZ Medicare	$14.84
Rate for Payer: Allwell Medicare	$7.95
Rate for Payer: Amerigroup Medicare	$7.95
Rate for Payer: APIPA Medicare/Medicaid	$19.80
Rate for Payer: AZCH Complete Medicare	$7.95
Rate for Payer: Banner UC Health Medicare	$7.95
Rate for Payer: Bisbee Police All Plans	$13.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$36.04
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cigna of AZ Commercial	$37.10
Rate for Payer: Copperpoint Commercial	$13.12
Rate for Payer: Health Net of AZ Commercial	$31.80
Rate for Payer: Health Net of AZ Medicare	$14.84
Rate for Payer: Humana of AZ Medicare	$7.95
Rate for Payer: Self Pay Self Pay	$42.40
Rate for Payer: TriWest Medicare	$7.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$30.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$9.54

ROOM/BED: Semi Private

Facility

$1,260.00

Hospital Charge Code	867361
Hospital Revenue Code	120
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$4,672.80
Rate for Payer: Aetna of AZ Commercial	$1,134.00
Rate for Payer: Aetna of AZ Medicare	$1,263.00
Rate for Payer: Allwell Medicare	$2,832.00
Rate for Payer: Amerigroup Medicare	$2,832.00
Rate for Payer: APIPA Medicare/Medicaid	$1,022.00
Rate for Payer: AZCH Complete Medicare	$2,832.00
Rate for Payer: Banner UC Health Medicare	$2,832.00
Rate for Payer: Bisbee Police All Plans	$327.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cigna of AZ Commercial	$1,700.00
Rate for Payer: Copperpoint Commercial	$4,672.80
Rate for Payer: Health Net of AZ Commercial	$1,231.00
Rate for Payer: Health Net of AZ Medicare	$1,176.00
Rate for Payer: Humana of AZ Medicare	$2,832.00
Rate for Payer: Self Pay Self Pay	$1,008.00
Rate for Payer: TriWest Medicare	$2,832.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,434.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,751.00

ROOM/BED: Swingbed

Facility

$1,260.00

Hospital Charge Code	11805353
Hospital Revenue Code	120
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$4,672.80
Rate for Payer: Aetna of AZ Commercial	$1,134.00
Rate for Payer: Aetna of AZ Medicare	$1,263.00
Rate for Payer: Allwell Medicare	$2,832.00
Rate for Payer: Amerigroup Medicare	$2,832.00
Rate for Payer: APIPA Medicare/Medicaid	$1,022.00
Rate for Payer: AZCH Complete Medicare	$2,832.00
Rate for Payer: Banner UC Health Medicare	$2,832.00
Rate for Payer: Bisbee Police All Plans	$327.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cigna of AZ Commercial	$1,700.00
Rate for Payer: Copperpoint Commercial	$4,672.80
Rate for Payer: Health Net of AZ Commercial	$1,231.00
Rate for Payer: Health Net of AZ Medicare	$1,176.00
Rate for Payer: Humana of AZ Medicare	$2,832.00
Rate for Payer: Self Pay Self Pay	$1,008.00
Rate for Payer: TriWest Medicare	$2,832.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,434.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,751.00

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
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

rOPINIRole 0.5 mg Tab [CQCH]

Facility

$0.09

Service Code	NDC 43547026910
Hospital Charge Code	105939910
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

rOPINIRole 2 mg Tab UD[CQCH]

Facility

$0.45

Service Code	NDC 50268074415
Hospital Charge Code	239908248
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Cash Price	$0.36
Rate for Payer: Self Pay Self Pay	$0.36

rOPINIRole 2 mg Tab UD[CQCH]

Facility

$0.45

Service Code	NDC 50268074415
Hospital Charge Code	239908248
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.17
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.31
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.32
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.27
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.36
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Cash Price	$3.41
Rate for Payer: Self Pay Self Pay	$3.41

ropivacaine HCl, 0.5%, 20 ml

Facility

$4.26

Service Code	NDC 63323028627
Hospital Charge Code	135066287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna of AZ Commercial	$3.83
Rate for Payer: Aetna of AZ Medicare	$1.19
Rate for Payer: Allwell Medicare	$0.64
Rate for Payer: Amerigroup Medicare	$0.64
Rate for Payer: APIPA Medicare/Medicaid	$1.59
Rate for Payer: AZCH Complete Medicare	$0.64
Rate for Payer: Banner UC Health Medicare	$0.64
Rate for Payer: Bisbee Police All Plans	$1.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2.90
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cigna of AZ Commercial	$2.77
Rate for Payer: Copperpoint Commercial	$1.05
Rate for Payer: Health Net of AZ Commercial	$2.56
Rate for Payer: Health Net of AZ Medicare	$1.19
Rate for Payer: Humana of AZ Medicare	$0.64
Rate for Payer: Self Pay Self Pay	$3.41
Rate for Payer: TriWest Medicare	$0.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$2.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.77

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Cash Price	$170.40
Rate for Payer: Self Pay Self Pay	$170.40

Rotatable Small Oval Snare Medium Stiffness

Facility

$213.00

Hospital Charge Code	22926473
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$191.70
Rate for Payer: Aetna of AZ Commercial	$191.70
Rate for Payer: Aetna of AZ Medicare	$59.64
Rate for Payer: Allwell Medicare	$31.95
Rate for Payer: Amerigroup Medicare	$31.95
Rate for Payer: APIPA Medicare/Medicaid	$79.56
Rate for Payer: AZCH Complete Medicare	$31.95
Rate for Payer: Banner UC Health Medicare	$31.95
Rate for Payer: Bisbee Police All Plans	$55.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$144.84
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cigna of AZ Commercial	$149.10
Rate for Payer: Copperpoint Commercial	$52.72
Rate for Payer: Health Net of AZ Commercial	$127.80
Rate for Payer: Health Net of AZ Medicare	$59.64
Rate for Payer: Humana of AZ Medicare	$31.95
Rate for Payer: Self Pay Self Pay	$170.40
Rate for Payer: TriWest Medicare	$31.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$124.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.34

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Aetna of AZ Medicare	$123.20
Rate for Payer: Allwell Medicare	$66.00
Rate for Payer: Amerigroup Medicare	$66.00
Rate for Payer: APIPA Medicare/Medicaid	$164.34
Rate for Payer: AZCH Complete Medicare	$66.00
Rate for Payer: Banner UC Health Medicare	$66.00
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$299.20
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna of AZ Commercial	$308.00
Rate for Payer: Copperpoint Commercial	$108.90
Rate for Payer: Health Net of AZ Commercial	$264.00
Rate for Payer: Health Net of AZ Medicare	$123.20
Rate for Payer: Humana of AZ Medicare	$66.00
Rate for Payer: Self Pay Self Pay	$352.00
Rate for Payer: TriWest Medicare	$66.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$256.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$79.20

ROTH NET

Facility

$440.00

Hospital Charge Code	22354323
Hospital Revenue Code	270
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna of AZ Commercial	$396.00
Rate for Payer: Bisbee Police All Plans	$114.40
Rate for Payer: Cash Price	$352.00
Rate for Payer: Self Pay Self Pay	$352.00

RPR LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$4.27
Rate for Payer: Allwell Medicaid	$4.27
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$4.27
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$4.27
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$4.27
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

RPR LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	2269415
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$4.27
Rate for Payer: Allwell Medicaid	$4.27
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$4.27
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$4.27
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$4.27
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

.RPR Qn+TP Abs LC

Facility

$65.00

Service Code	CPT 86592
Hospital Charge Code	22311166
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Know your out-of-pocket cost for care.

All Charges