Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

SURGICAL GOWN XL

Facility

$24.00

Hospital Charge Code	22354414
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Self Pay Self Pay	$19.20

SURGICAL GOWN XL

Facility

$24.00

Hospital Charge Code	22354414
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Aetna of AZ Medicare	$6.72
Rate for Payer: Allwell Medicare	$3.60
Rate for Payer: Amerigroup Medicare	$3.60
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.60
Rate for Payer: Banner UC Health Medicare	$3.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.32
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Copperpoint Commercial	$5.94
Rate for Payer: Health Net of AZ Commercial	$14.40
Rate for Payer: Health Net of AZ Medicare	$6.72
Rate for Payer: Humana of AZ Medicare	$3.60
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.32

SURGICAL GOWN XXL

Facility

$24.00

Hospital Charge Code	22355428
Hospital Revenue Code	272
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Cash Price	$19.20
Rate for Payer: Self Pay Self Pay	$19.20

SURGICAL GOWN XXL

Facility

$24.00

Hospital Charge Code	22355428
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of AZ Commercial	$21.60
Rate for Payer: Aetna of AZ Medicare	$6.72
Rate for Payer: Allwell Medicare	$3.60
Rate for Payer: Amerigroup Medicare	$3.60
Rate for Payer: APIPA Medicare/Medicaid	$8.96
Rate for Payer: AZCH Complete Medicare	$3.60
Rate for Payer: Banner UC Health Medicare	$3.60
Rate for Payer: Bisbee Police All Plans	$6.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$16.32
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cigna of AZ Commercial	$16.80
Rate for Payer: Copperpoint Commercial	$5.94
Rate for Payer: Health Net of AZ Commercial	$14.40
Rate for Payer: Health Net of AZ Medicare	$6.72
Rate for Payer: Humana of AZ Medicare	$3.60
Rate for Payer: Self Pay Self Pay	$19.20
Rate for Payer: TriWest Medicare	$3.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$13.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$4.32

SURGICEL 0.5X2-IN

Facility

$176.00

Hospital Charge Code	22355174
Hospital Revenue Code	270
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Aetna of AZ Medicare	$49.28
Rate for Payer: Allwell Medicare	$26.40
Rate for Payer: Amerigroup Medicare	$26.40
Rate for Payer: APIPA Medicare/Medicaid	$65.74
Rate for Payer: AZCH Complete Medicare	$26.40
Rate for Payer: Banner UC Health Medicare	$26.40
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$119.68
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna of AZ Commercial	$123.20
Rate for Payer: Copperpoint Commercial	$43.56
Rate for Payer: Health Net of AZ Commercial	$105.60
Rate for Payer: Health Net of AZ Medicare	$49.28
Rate for Payer: Humana of AZ Medicare	$26.40
Rate for Payer: Self Pay Self Pay	$140.80
Rate for Payer: TriWest Medicare	$26.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$102.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.68

SURGICEL 0.5X2-IN

Facility

$176.00

Hospital Charge Code	22355174
Hospital Revenue Code	270
Min. Negotiated Rate	$45.76
Max. Negotiated Rate	$158.40
Rate for Payer: Aetna of AZ Commercial	$158.40
Rate for Payer: Bisbee Police All Plans	$45.76
Rate for Payer: Cash Price	$140.80
Rate for Payer: Self Pay Self Pay	$140.80

SURGIFOAM 2CMX6CMX7MM

Facility

$78.00

Hospital Charge Code	27569184
Hospital Revenue Code	270
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Cash Price	$62.40
Rate for Payer: Self Pay Self Pay	$62.40

SURGIFOAM 2CMX6CMX7MM

Facility

$78.00

Hospital Charge Code	27569184
Hospital Revenue Code	270
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: Allwell Medicare	$11.70
Rate for Payer: Amerigroup Medicare	$11.70
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicare	$11.70
Rate for Payer: Banner UC Health Medicare	$11.70
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$11.70
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$11.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

SURGIFOAM GELATIN SPONGE 8CMX12CMX10MM

Facility

$259.00

Hospital Charge Code	27569183
Hospital Revenue Code	270
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Cash Price	$207.20
Rate for Payer: Self Pay Self Pay	$207.20

SURGIFOAM GELATIN SPONGE 8CMX12CMX10MM

Facility

$259.00

Hospital Charge Code	27569183
Hospital Revenue Code	270
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$233.10
Rate for Payer: Aetna of AZ Commercial	$233.10
Rate for Payer: Aetna of AZ Medicare	$72.52
Rate for Payer: Allwell Medicare	$38.85
Rate for Payer: Amerigroup Medicare	$38.85
Rate for Payer: APIPA Medicare/Medicaid	$96.74
Rate for Payer: AZCH Complete Medicare	$38.85
Rate for Payer: Banner UC Health Medicare	$38.85
Rate for Payer: Bisbee Police All Plans	$67.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$176.12
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cigna of AZ Commercial	$181.30
Rate for Payer: Copperpoint Commercial	$64.10
Rate for Payer: Health Net of AZ Commercial	$155.40
Rate for Payer: Health Net of AZ Medicare	$72.52
Rate for Payer: Humana of AZ Medicare	$38.85
Rate for Payer: Self Pay Self Pay	$207.20
Rate for Payer: TriWest Medicare	$38.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$151.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.62

SURG PATH LVL 1 GROSS EXAM

Facility

$91.00

Service Code	CPT 88300
Hospital Charge Code	22545711
Hospital Revenue Code	310
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Aetna of AZ Medicare	$25.48
Rate for Payer: AHCCCS Medicaid	$17.89
Rate for Payer: Allwell Medicaid	$17.89
Rate for Payer: Allwell Medicare	$13.65
Rate for Payer: Amerigroup Medicare	$13.65
Rate for Payer: APIPA Medicare/Medicaid	$33.99
Rate for Payer: AZCH Complete Medicaid	$17.89
Rate for Payer: AZCH Complete Medicare	$13.65
Rate for Payer: Banner UC Health Medicaid	$17.89
Rate for Payer: Banner UC Health Medicare	$13.65
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.88
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$59.15
Rate for Payer: Copperpoint Commercial	$22.52
Rate for Payer: Health Net of AZ Commercial	$54.60
Rate for Payer: Health Net of AZ Medicare	$25.48
Rate for Payer: Humana of AZ Medicare	$13.65
Rate for Payer: Mercy Care Medicaid	$17.89
Rate for Payer: Self Pay Self Pay	$72.80
Rate for Payer: TriWest Medicare	$13.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.38

SURG PATH LVL 1 GROSS EXAM

Facility

$91.00

Service Code	CPT 88300
Hospital Charge Code	22545711
Hospital Revenue Code	310
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Cash Price	$72.80
Rate for Payer: Self Pay Self Pay	$72.80

SURG PATH LVL 2 GROSS EXAM

Facility

$745.00

Service Code	CPT 88302
Hospital Charge Code	22545712
Hospital Revenue Code	310
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$670.50
Rate for Payer: Aetna of AZ Commercial	$670.50
Rate for Payer: Aetna of AZ Medicare	$208.60
Rate for Payer: AHCCCS Medicaid	$17.89
Rate for Payer: Allwell Medicaid	$17.89
Rate for Payer: Allwell Medicare	$111.75
Rate for Payer: Amerigroup Medicare	$111.75
Rate for Payer: APIPA Medicare/Medicaid	$278.26
Rate for Payer: AZCH Complete Medicaid	$17.89
Rate for Payer: AZCH Complete Medicare	$111.75
Rate for Payer: Banner UC Health Medicaid	$17.89
Rate for Payer: Banner UC Health Medicare	$111.75
Rate for Payer: Bisbee Police All Plans	$193.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$506.60
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cigna of AZ Commercial	$484.25
Rate for Payer: Copperpoint Commercial	$184.39
Rate for Payer: Health Net of AZ Commercial	$447.00
Rate for Payer: Health Net of AZ Medicare	$208.60
Rate for Payer: Humana of AZ Medicare	$111.75
Rate for Payer: Mercy Care Medicaid	$17.89
Rate for Payer: Self Pay Self Pay	$596.00
Rate for Payer: TriWest Medicare	$111.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$434.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$134.10

SURG PATH LVL 2 GROSS EXAM

Facility

$745.00

Service Code	CPT 88302
Hospital Charge Code	22545712
Hospital Revenue Code	310
Min. Negotiated Rate	$193.70
Max. Negotiated Rate	$670.50
Rate for Payer: Aetna of AZ Commercial	$670.50
Rate for Payer: Bisbee Police All Plans	$193.70
Rate for Payer: Cash Price	$596.00
Rate for Payer: Self Pay Self Pay	$596.00

SURG PATH LVL 3 GROSS EXAM

Facility

$874.00

Service Code	CPT 88304
Hospital Charge Code	22545713
Hospital Revenue Code	310
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$786.60
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Aetna of AZ Medicare	$244.72
Rate for Payer: AHCCCS Medicaid	$36.08
Rate for Payer: Allwell Medicaid	$36.08
Rate for Payer: Allwell Medicare	$131.10
Rate for Payer: Amerigroup Medicare	$131.10
Rate for Payer: APIPA Medicare/Medicaid	$326.44
Rate for Payer: AZCH Complete Medicaid	$36.08
Rate for Payer: AZCH Complete Medicare	$131.10
Rate for Payer: Banner UC Health Medicaid	$36.08
Rate for Payer: Banner UC Health Medicare	$131.10
Rate for Payer: Bisbee Police All Plans	$227.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$594.32
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cigna of AZ Commercial	$568.10
Rate for Payer: Copperpoint Commercial	$216.32
Rate for Payer: Health Net of AZ Commercial	$524.40
Rate for Payer: Health Net of AZ Medicare	$244.72
Rate for Payer: Humana of AZ Medicare	$131.10
Rate for Payer: Mercy Care Medicaid	$36.08
Rate for Payer: Self Pay Self Pay	$699.20
Rate for Payer: TriWest Medicare	$131.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$509.54
Rate for Payer: UnitedHealth Group of AZ Medicare	$157.32

SURG PATH LVL 3 GROSS EXAM

Facility

$874.00

Service Code	CPT 88304
Hospital Charge Code	22545713
Hospital Revenue Code	310
Min. Negotiated Rate	$227.24
Max. Negotiated Rate	$786.60
Rate for Payer: Aetna of AZ Commercial	$786.60
Rate for Payer: Bisbee Police All Plans	$227.24
Rate for Payer: Cash Price	$699.20
Rate for Payer: Self Pay Self Pay	$699.20

SURG PATH LVL 4 GROSS EXAM

Facility

$1,269.00

Service Code	CPT 88305
Hospital Charge Code	22545714
Hospital Revenue Code	310
Min. Negotiated Rate	$329.94
Max. Negotiated Rate	$1,142.10
Rate for Payer: Aetna of AZ Commercial	$1,142.10
Rate for Payer: Bisbee Police All Plans	$329.94
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Self Pay Self Pay	$1,015.20

SURG PATH LVL 4 GROSS EXAM

Facility

$1,269.00

Service Code	CPT 88305
Hospital Charge Code	22545714
Hospital Revenue Code	310
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$1,142.10
Rate for Payer: Aetna of AZ Commercial	$1,142.10
Rate for Payer: Aetna of AZ Medicare	$355.32
Rate for Payer: AHCCCS Medicaid	$36.08
Rate for Payer: Allwell Medicaid	$36.08
Rate for Payer: Allwell Medicare	$190.35
Rate for Payer: Amerigroup Medicare	$190.35
Rate for Payer: APIPA Medicare/Medicaid	$473.97
Rate for Payer: AZCH Complete Medicaid	$36.08
Rate for Payer: AZCH Complete Medicare	$190.35
Rate for Payer: Banner UC Health Medicaid	$36.08
Rate for Payer: Banner UC Health Medicare	$190.35
Rate for Payer: Bisbee Police All Plans	$329.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$862.92
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cigna of AZ Commercial	$824.85
Rate for Payer: Copperpoint Commercial	$314.08
Rate for Payer: Health Net of AZ Commercial	$761.40
Rate for Payer: Health Net of AZ Medicare	$355.32
Rate for Payer: Humana of AZ Medicare	$190.35
Rate for Payer: Mercy Care Medicaid	$36.08
Rate for Payer: Self Pay Self Pay	$1,015.20
Rate for Payer: TriWest Medicare	$190.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$739.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$228.42

SURG PATH LVL 5 GROSS EXAM

Facility

$5,042.00

Service Code	CPT 88307
Hospital Charge Code	22545715
Hospital Revenue Code	310
Min. Negotiated Rate	$211.16
Max. Negotiated Rate	$4,537.80
Rate for Payer: Aetna of AZ Commercial	$4,537.80
Rate for Payer: Aetna of AZ Medicare	$1,411.76
Rate for Payer: AHCCCS Medicaid	$211.16
Rate for Payer: Allwell Medicaid	$211.16
Rate for Payer: Allwell Medicare	$756.30
Rate for Payer: Amerigroup Medicare	$756.30
Rate for Payer: APIPA Medicare/Medicaid	$1,883.19
Rate for Payer: AZCH Complete Medicaid	$211.16
Rate for Payer: AZCH Complete Medicare	$756.30
Rate for Payer: Banner UC Health Medicaid	$211.16
Rate for Payer: Banner UC Health Medicare	$756.30
Rate for Payer: Bisbee Police All Plans	$1,310.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,428.56
Rate for Payer: Cash Price	$4,033.60
Rate for Payer: Cash Price	$4,033.60
Rate for Payer: Cigna of AZ Commercial	$3,277.30
Rate for Payer: Copperpoint Commercial	$1,247.90
Rate for Payer: Health Net of AZ Commercial	$3,025.20
Rate for Payer: Health Net of AZ Medicare	$1,411.76
Rate for Payer: Humana of AZ Medicare	$756.30
Rate for Payer: Mercy Care Medicaid	$211.16
Rate for Payer: Self Pay Self Pay	$4,033.60
Rate for Payer: TriWest Medicare	$756.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,939.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$907.56

SURG PATH LVL 5 GROSS EXAM

Facility

$5,042.00

Service Code	CPT 88307
Hospital Charge Code	22545715
Hospital Revenue Code	310
Min. Negotiated Rate	$1,310.92
Max. Negotiated Rate	$4,537.80
Rate for Payer: Aetna of AZ Commercial	$4,537.80
Rate for Payer: Bisbee Police All Plans	$1,310.92
Rate for Payer: Cash Price	$4,033.60
Rate for Payer: Self Pay Self Pay	$4,033.60

SURG PATH LVL 6 GROSS EXAM

Facility

$7,500.00

Service Code	CPT 88309
Hospital Charge Code	22545716
Hospital Revenue Code	310
Min. Negotiated Rate	$475.71
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna of AZ Commercial	$6,750.00
Rate for Payer: Aetna of AZ Medicare	$2,100.00
Rate for Payer: AHCCCS Medicaid	$475.71
Rate for Payer: Allwell Medicaid	$475.71
Rate for Payer: Allwell Medicare	$1,125.00
Rate for Payer: Amerigroup Medicare	$1,125.00
Rate for Payer: APIPA Medicare/Medicaid	$2,801.25
Rate for Payer: AZCH Complete Medicaid	$475.71
Rate for Payer: AZCH Complete Medicare	$1,125.00
Rate for Payer: Banner UC Health Medicaid	$475.71
Rate for Payer: Banner UC Health Medicare	$1,125.00
Rate for Payer: Bisbee Police All Plans	$1,950.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$5,100.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Cigna of AZ Commercial	$4,875.00
Rate for Payer: Copperpoint Commercial	$1,856.25
Rate for Payer: Health Net of AZ Commercial	$4,500.00
Rate for Payer: Health Net of AZ Medicare	$2,100.00
Rate for Payer: Humana of AZ Medicare	$1,125.00
Rate for Payer: Mercy Care Medicaid	$475.71
Rate for Payer: Self Pay Self Pay	$6,000.00
Rate for Payer: TriWest Medicare	$1,125.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$4,372.50
Rate for Payer: UnitedHealth Group of AZ Medicare	$1,350.00

SURG PATH LVL 6 GROSS EXAM

Facility

$7,500.00

Service Code	CPT 88309
Hospital Charge Code	22545716
Hospital Revenue Code	310
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna of AZ Commercial	$6,750.00
Rate for Payer: Bisbee Police All Plans	$1,950.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Self Pay Self Pay	$6,000.00

SUSPENSORY MALE LG

Facility

$82.00

Hospital Charge Code	22355538
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$57.40
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

SUSPENSORY MALE LG

Facility

$82.00

Hospital Charge Code	22355538
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Cash Price	$65.60
Rate for Payer: Self Pay Self Pay	$65.60

SUSPENSORY MALE MED

Facility

$82.00

Hospital Charge Code	22354142
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$73.80
Rate for Payer: Aetna of AZ Commercial	$73.80
Rate for Payer: Aetna of AZ Medicare	$22.96
Rate for Payer: Allwell Medicare	$12.30
Rate for Payer: Amerigroup Medicare	$12.30
Rate for Payer: APIPA Medicare/Medicaid	$30.63
Rate for Payer: AZCH Complete Medicare	$12.30
Rate for Payer: Banner UC Health Medicare	$12.30
Rate for Payer: Bisbee Police All Plans	$21.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$55.76
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cigna of AZ Commercial	$57.40
Rate for Payer: Copperpoint Commercial	$20.30
Rate for Payer: Health Net of AZ Commercial	$49.20
Rate for Payer: Health Net of AZ Medicare	$22.96
Rate for Payer: Humana of AZ Medicare	$12.30
Rate for Payer: Self Pay Self Pay	$65.60
Rate for Payer: TriWest Medicare	$12.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$47.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.76

Know your out-of-pocket cost for care.

All Charges