Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

.RPR, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
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, Quant LC

Facility

$65.00

Service Code	CPT 86593
Hospital Charge Code	3033479
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
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	$4.40
Rate for Payer: Allwell Medicaid	$4.40
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	$4.40
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$4.40
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	$4.40
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, Rfx Qn RPR/Confirm TP LC

Facility

$68.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Aetna of AZ Medicare	$19.04
Rate for Payer: AHCCCS Medicaid	$4.27
Rate for Payer: Allwell Medicaid	$4.27
Rate for Payer: Allwell Medicare	$10.20
Rate for Payer: Amerigroup Medicare	$10.20
Rate for Payer: APIPA Medicare/Medicaid	$25.40
Rate for Payer: AZCH Complete Medicaid	$4.27
Rate for Payer: AZCH Complete Medicare	$10.20
Rate for Payer: Banner UC Health Medicaid	$4.27
Rate for Payer: Banner UC Health Medicare	$10.20
Rate for Payer: Bisbee Police All Plans	$17.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$46.24
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cigna of AZ Commercial	$44.20
Rate for Payer: Copperpoint Commercial	$16.83
Rate for Payer: Health Net of AZ Commercial	$40.80
Rate for Payer: Health Net of AZ Medicare	$19.04
Rate for Payer: Humana of AZ Medicare	$10.20
Rate for Payer: Mercy Care Medicaid	$4.27
Rate for Payer: Self Pay Self Pay	$54.40
Rate for Payer: TriWest Medicare	$10.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.24

RPR, Rfx Qn RPR/Confirm TP LC

Facility

$68.00

Service Code	CPT 86592
Hospital Charge Code	22201655
Hospital Revenue Code	302
Min. Negotiated Rate	$17.68
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna of AZ Commercial	$61.20
Rate for Payer: Bisbee Police All Plans	$17.68
Rate for Payer: Cash Price	$54.40
Rate for Payer: Self Pay Self Pay	$54.40

RT Continuous Neb Subsequent Charge

Facility

$298.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$77.48
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Cash Price	$238.40
Rate for Payer: Self Pay Self Pay	$238.40

RT Continuous Neb Subsequent Charge

Facility

$298.00

Service Code	CPT 94645
Hospital Charge Code	3230232
Hospital Revenue Code	410
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$268.20
Rate for Payer: Aetna of AZ Commercial	$268.20
Rate for Payer: Aetna of AZ Medicare	$83.44
Rate for Payer: AHCCCS Medicaid	$95.74
Rate for Payer: Allwell Medicaid	$95.74
Rate for Payer: Allwell Medicare	$44.70
Rate for Payer: Amerigroup Medicare	$44.70
Rate for Payer: APIPA Medicare/Medicaid	$111.30
Rate for Payer: AZCH Complete Medicaid	$95.74
Rate for Payer: AZCH Complete Medicare	$44.70
Rate for Payer: Banner UC Health Medicaid	$95.74
Rate for Payer: Banner UC Health Medicare	$44.70
Rate for Payer: Bisbee Police All Plans	$77.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$202.64
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cigna of AZ Commercial	$208.60
Rate for Payer: Copperpoint Commercial	$73.76
Rate for Payer: Health Net of AZ Commercial	$178.80
Rate for Payer: Health Net of AZ Medicare	$83.44
Rate for Payer: Humana of AZ Medicare	$44.70
Rate for Payer: Mercy Care Medicaid	$95.74
Rate for Payer: Self Pay Self Pay	$238.40
Rate for Payer: TriWest Medicare	$44.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$173.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.64

RT ETC02 Monitoring Charge

Facility

$717.00

Service Code	CPT G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$107.55
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Aetna of AZ Medicare	$200.76
Rate for Payer: Allwell Medicare	$107.55
Rate for Payer: Amerigroup Medicare	$107.55
Rate for Payer: APIPA Medicare/Medicaid	$267.80
Rate for Payer: AZCH Complete Medicare	$107.55
Rate for Payer: Banner UC Health Medicare	$107.55
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$487.56
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cigna of AZ Commercial	$501.90
Rate for Payer: Copperpoint Commercial	$177.46
Rate for Payer: Health Net of AZ Commercial	$430.20
Rate for Payer: Health Net of AZ Medicare	$200.76
Rate for Payer: Humana of AZ Medicare	$107.55
Rate for Payer: Self Pay Self Pay	$573.60
Rate for Payer: TriWest Medicare	$107.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$418.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.06

RT ETC02 Monitoring Charge

Facility

$717.00

Service Code	CPT G0238
Hospital Charge Code	1886873
Hospital Revenue Code	410
Min. Negotiated Rate	$186.42
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Cash Price	$573.60
Rate for Payer: Self Pay Self Pay	$573.60

RT Ventilator Services - Subs Charge

Facility

$2,858.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$743.08
Max. Negotiated Rate	$2,572.20
Rate for Payer: Aetna of AZ Commercial	$2,572.20
Rate for Payer: Bisbee Police All Plans	$743.08
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Self Pay Self Pay	$2,286.40

RT Ventilator Services - Subs Charge

Facility

$2,858.00

Service Code	CPT 94003
Hospital Charge Code	1886948
Hospital Revenue Code	410
Min. Negotiated Rate	$428.70
Max. Negotiated Rate	$2,572.20
Rate for Payer: Aetna of AZ Commercial	$2,572.20
Rate for Payer: Aetna of AZ Medicare	$800.24
Rate for Payer: AHCCCS Medicaid	$703.62
Rate for Payer: Allwell Medicaid	$703.62
Rate for Payer: Allwell Medicare	$428.70
Rate for Payer: Amerigroup Medicare	$428.70
Rate for Payer: APIPA Medicare/Medicaid	$1,067.46
Rate for Payer: AZCH Complete Medicaid	$703.62
Rate for Payer: AZCH Complete Medicare	$428.70
Rate for Payer: Banner UC Health Medicaid	$703.62
Rate for Payer: Banner UC Health Medicare	$428.70
Rate for Payer: Bisbee Police All Plans	$743.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,943.44
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cigna of AZ Commercial	$2,000.60
Rate for Payer: Copperpoint Commercial	$707.36
Rate for Payer: Health Net of AZ Commercial	$1,714.80
Rate for Payer: Health Net of AZ Medicare	$800.24
Rate for Payer: Humana of AZ Medicare	$428.70
Rate for Payer: Mercy Care Medicaid	$703.62
Rate for Payer: Self Pay Self Pay	$2,286.40
Rate for Payer: TriWest Medicare	$428.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,666.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$514.44

Rubella Antibodies, IgG LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Rubella Antibodies, IgG LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2029257
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.39
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Mercy Care Medicaid	$14.39
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.39
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Mercy Care Medicaid	$14.39
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

Rubella Antibody, IgM LC

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	2446665
Hospital Revenue Code	302
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Aetna of AZ Medicare	$50.68
Rate for Payer: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
Rate for Payer: Allwell Medicare	$27.15
Rate for Payer: Amerigroup Medicare	$27.15
Rate for Payer: APIPA Medicare/Medicaid	$67.60
Rate for Payer: AZCH Complete Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$27.15
Rate for Payer: Banner UC Health Medicaid	$14.39
Rate for Payer: Banner UC Health Medicare	$27.15
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$123.08
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cigna of AZ Commercial	$117.65
Rate for Payer: Copperpoint Commercial	$44.80
Rate for Payer: Health Net of AZ Commercial	$108.60
Rate for Payer: Health Net of AZ Medicare	$50.68
Rate for Payer: Humana of AZ Medicare	$27.15
Rate for Payer: Mercy Care Medicaid	$14.39
Rate for Payer: Self Pay Self Pay	$144.80
Rate for Payer: TriWest Medicare	$27.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$105.52
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.58

RUBELLA IGG

Facility

$181.00

Service Code	CPT 86762
Hospital Charge Code	22481502
Hospital Revenue Code	302
Min. Negotiated Rate	$47.06
Max. Negotiated Rate	$162.90
Rate for Payer: Aetna of AZ Commercial	$162.90
Rate for Payer: Bisbee Police All Plans	$47.06
Rate for Payer: Cash Price	$144.80
Rate for Payer: Self Pay Self Pay	$144.80

Rubeola Antibodies, IgG LC

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22201672
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: AHCCCS Medicaid	$12.88
Rate for Payer: Allwell Medicaid	$12.88
Rate for Payer: Allwell Medicare	$34.50
Rate for Payer: Amerigroup Medicare	$34.50
Rate for Payer: APIPA Medicare/Medicaid	$85.90
Rate for Payer: AZCH Complete Medicaid	$12.88
Rate for Payer: AZCH Complete Medicare	$34.50
Rate for Payer: Banner UC Health Medicaid	$12.88
Rate for Payer: Banner UC Health Medicare	$34.50
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$149.50
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$34.50
Rate for Payer: Mercy Care Medicaid	$12.88
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$34.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

Rubeola Antibodies, IgG LC

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22201672
Hospital Revenue Code	302
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

RUBEOLA IGG

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22481503
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: AHCCCS Medicaid	$12.88
Rate for Payer: Allwell Medicaid	$12.88
Rate for Payer: Allwell Medicare	$34.50
Rate for Payer: Amerigroup Medicare	$34.50
Rate for Payer: APIPA Medicare/Medicaid	$85.90
Rate for Payer: AZCH Complete Medicaid	$12.88
Rate for Payer: AZCH Complete Medicare	$34.50
Rate for Payer: Banner UC Health Medicaid	$12.88
Rate for Payer: Banner UC Health Medicare	$34.50
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$149.50
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$34.50
Rate for Payer: Mercy Care Medicaid	$12.88
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$34.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

RUBEOLA IGG

Facility

$230.00

Service Code	CPT 86765
Hospital Charge Code	22481503
Hospital Revenue Code	302
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

Rubeola IgM LC

Facility

$242.00

Service Code	CPT 86765
Hospital Charge Code	6780983
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Medicare	$67.76
Rate for Payer: AHCCCS Medicaid	$12.88
Rate for Payer: Allwell Medicaid	$12.88
Rate for Payer: Allwell Medicare	$36.30
Rate for Payer: Amerigroup Medicare	$36.30
Rate for Payer: APIPA Medicare/Medicaid	$90.39
Rate for Payer: AZCH Complete Medicaid	$12.88
Rate for Payer: AZCH Complete Medicare	$36.30
Rate for Payer: Banner UC Health Medicaid	$12.88
Rate for Payer: Banner UC Health Medicare	$36.30
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.56
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$157.30
Rate for Payer: Copperpoint Commercial	$59.90
Rate for Payer: Health Net of AZ Commercial	$145.20
Rate for Payer: Health Net of AZ Medicare	$67.76
Rate for Payer: Humana of AZ Medicare	$36.30
Rate for Payer: Mercy Care Medicaid	$12.88
Rate for Payer: Self Pay Self Pay	$193.60
Rate for Payer: TriWest Medicare	$36.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.56

Rubeola IgM LC

Facility

$242.00

Service Code	CPT 86765
Hospital Charge Code	6780983
Hospital Revenue Code	302
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Cash Price	$193.60
Rate for Payer: Self Pay Self Pay	$193.60

Sacrospinous ligament fixaton

Facility

$3,595.00

Service Code	CPT 57282
Hospital Charge Code	27267823
Hospital Revenue Code	360
Min. Negotiated Rate	$539.25
Max. Negotiated Rate	$9,851.74
Rate for Payer: Aetna of AZ Commercial	$3,235.50
Rate for Payer: Aetna of AZ Medicare	$1,006.60
Rate for Payer: AHCCCS Medicaid	$9,851.74
Rate for Payer: Allwell Medicaid	$9,851.74
Rate for Payer: Allwell Medicare	$539.25
Rate for Payer: Amerigroup Medicare	$539.25
Rate for Payer: APIPA Medicare/Medicaid	$1,342.73
Rate for Payer: AZCH Complete Medicaid	$9,851.74
Rate for Payer: AZCH Complete Medicare	$539.25
Rate for Payer: Banner UC Health Medicaid	$9,851.74
Rate for Payer: Banner UC Health Medicare	$539.25
Rate for Payer: Bisbee Police All Plans	$934.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,444.60
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Cigna of AZ Commercial	$1,797.50
Rate for Payer: Copperpoint Commercial	$889.76
Rate for Payer: Health Net of AZ Commercial	$2,157.00
Rate for Payer: Health Net of AZ Medicare	$1,006.60
Rate for Payer: Humana of AZ Medicare	$539.25
Rate for Payer: Mercy Care Medicaid	$9,851.74
Rate for Payer: Self Pay Self Pay	$2,876.00
Rate for Payer: TriWest Medicare	$539.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,540.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$647.10

Sacrospinous ligament fixaton

Facility

$3,595.00

Service Code	CPT 57282
Hospital Charge Code	27267823
Hospital Revenue Code	360
Min. Negotiated Rate	$934.70
Max. Negotiated Rate	$3,235.50
Rate for Payer: Aetna of AZ Commercial	$3,235.50
Rate for Payer: Bisbee Police All Plans	$934.70
Rate for Payer: Cash Price	$2,876.00
Rate for Payer: Self Pay Self Pay	$2,876.00

Salicylate Level

Facility

$189.00

Service Code	CPT G0480
Hospital Charge Code	633829
Hospital Revenue Code	301
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Cash Price	$151.20
Rate for Payer: Self Pay Self Pay	$151.20

Know your out-of-pocket cost for care.

All Charges