Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TROCAR TIP PLAIN GUIDE WIRES 2 X 150

Facility

$185.00

Hospital Charge Code	27339077
Hospital Revenue Code	270
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna of AZ Commercial	$166.50
Rate for Payer: Aetna of AZ Medicare	$51.80
Rate for Payer: Allwell Medicare	$27.75
Rate for Payer: Amerigroup Medicare	$27.75
Rate for Payer: APIPA Medicare/Medicaid	$69.10
Rate for Payer: AZCH Complete Medicare	$27.75
Rate for Payer: Banner UC Health Medicare	$27.75
Rate for Payer: Bisbee Police All Plans	$48.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$125.80
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cigna of AZ Commercial	$129.50
Rate for Payer: Copperpoint Commercial	$45.79
Rate for Payer: Health Net of AZ Commercial	$111.00
Rate for Payer: Health Net of AZ Medicare	$51.80
Rate for Payer: Humana of AZ Medicare	$27.75
Rate for Payer: Self Pay Self Pay	$148.00
Rate for Payer: TriWest Medicare	$27.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$107.86
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.30

TROCAR VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$59.70
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Aetna of AZ Medicare	$111.44
Rate for Payer: Allwell Medicare	$59.70
Rate for Payer: Amerigroup Medicare	$59.70
Rate for Payer: APIPA Medicare/Medicaid	$148.65
Rate for Payer: AZCH Complete Medicare	$59.70
Rate for Payer: Banner UC Health Medicare	$59.70
Rate for Payer: Bisbee Police All Plans	$103.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$270.64
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cigna of AZ Commercial	$278.60
Rate for Payer: Copperpoint Commercial	$98.50
Rate for Payer: Health Net of AZ Commercial	$238.80
Rate for Payer: Health Net of AZ Medicare	$111.44
Rate for Payer: Humana of AZ Medicare	$59.70
Rate for Payer: Self Pay Self Pay	$318.40
Rate for Payer: TriWest Medicare	$59.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$232.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$71.64

TROCAR VERSAPORT 8MM

Facility

$398.00

Hospital Charge Code	22354264
Hospital Revenue Code	270
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$358.20
Rate for Payer: Aetna of AZ Commercial	$358.20
Rate for Payer: Bisbee Police All Plans	$103.48
Rate for Payer: Cash Price	$318.40
Rate for Payer: Self Pay Self Pay	$318.40

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

TROCAR W/SHIELD 5MM CONMED

Facility

$203.00

Hospital Charge Code	22354869
Hospital Revenue Code	270
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: Allwell Medicare	$30.45
Rate for Payer: Amerigroup Medicare	$30.45
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicare	$30.45
Rate for Payer: Banner UC Health Medicare	$30.45
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$142.10
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$30.45
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$30.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

TROCAR XCEL BLADELESS 8MM

Facility

$186.00

Hospital Charge Code	22354868
Hospital Revenue Code	270
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: Allwell Medicare	$27.90
Rate for Payer: Amerigroup Medicare	$27.90
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicare	$27.90
Rate for Payer: Banner UC Health Medicare	$27.90
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$130.20
Rate for Payer: Copperpoint Commercial	$46.04
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$27.90
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$27.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Aetna of AZ Medicare	$17.38
Rate for Payer: Allwell Medicare	$9.31
Rate for Payer: Amerigroup Medicare	$9.31
Rate for Payer: APIPA Medicare/Medicaid	$23.18
Rate for Payer: AZCH Complete Medicare	$9.31
Rate for Payer: Banner UC Health Medicare	$9.31
Rate for Payer: Bisbee Police All Plans	$16.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.20
Rate for Payer: Cash Price	$49.65
Rate for Payer: Cigna of AZ Commercial	$43.44
Rate for Payer: Copperpoint Commercial	$15.36
Rate for Payer: Health Net of AZ Commercial	$37.24
Rate for Payer: Health Net of AZ Medicare	$17.38
Rate for Payer: Humana of AZ Medicare	$9.31
Rate for Payer: Self Pay Self Pay	$49.65
Rate for Payer: TriWest Medicare	$9.31
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.18
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.17

TROCLEAN TROCAR CLEANING DEVICE

Facility

$62.06

Hospital Charge Code	27446586
Hospital Revenue Code	270
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$55.85
Rate for Payer: Aetna of AZ Commercial	$55.85
Rate for Payer: Bisbee Police All Plans	$16.14
Rate for Payer: Cash Price	$49.65
Rate for Payer: Self Pay Self Pay	$49.65

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Aetna of AZ Medicare	$87.08
Rate for Payer: AHCCCS Medicaid	$12.47
Rate for Payer: Allwell Medicaid	$12.47
Rate for Payer: Allwell Medicare	$46.65
Rate for Payer: Amerigroup Medicare	$46.65
Rate for Payer: APIPA Medicare/Medicaid	$116.16
Rate for Payer: AZCH Complete Medicaid	$12.47
Rate for Payer: AZCH Complete Medicare	$46.65
Rate for Payer: Banner UC Health Medicaid	$12.47
Rate for Payer: Banner UC Health Medicare	$46.65
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$211.48
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Copperpoint Commercial	$76.97
Rate for Payer: Health Net of AZ Commercial	$186.60
Rate for Payer: Health Net of AZ Medicare	$87.08
Rate for Payer: Humana of AZ Medicare	$46.65
Rate for Payer: Mercy Care Medicaid	$12.47
Rate for Payer: Self Pay Self Pay	$248.80
Rate for Payer: TriWest Medicare	$46.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.98

Troponin

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	22525240
Hospital Revenue Code	301
Min. Negotiated Rate	$80.86
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Cash Price	$248.80
Rate for Payer: Self Pay Self Pay	$248.80

Troponin I

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$80.86
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Cash Price	$248.80
Rate for Payer: Self Pay Self Pay	$248.80

Troponin I

Facility

$311.00

Service Code	CPT 84484
Hospital Charge Code	908527
Hospital Revenue Code	301
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$279.90
Rate for Payer: Aetna of AZ Commercial	$279.90
Rate for Payer: Aetna of AZ Medicare	$87.08
Rate for Payer: AHCCCS Medicaid	$12.47
Rate for Payer: Allwell Medicaid	$12.47
Rate for Payer: Allwell Medicare	$46.65
Rate for Payer: Amerigroup Medicare	$46.65
Rate for Payer: APIPA Medicare/Medicaid	$116.16
Rate for Payer: AZCH Complete Medicaid	$12.47
Rate for Payer: AZCH Complete Medicare	$46.65
Rate for Payer: Banner UC Health Medicaid	$12.47
Rate for Payer: Banner UC Health Medicare	$46.65
Rate for Payer: Bisbee Police All Plans	$80.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$211.48
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cigna of AZ Commercial	$202.15
Rate for Payer: Copperpoint Commercial	$76.97
Rate for Payer: Health Net of AZ Commercial	$186.60
Rate for Payer: Health Net of AZ Medicare	$87.08
Rate for Payer: Humana of AZ Medicare	$46.65
Rate for Payer: Mercy Care Medicaid	$12.47
Rate for Payer: Self Pay Self Pay	$248.80
Rate for Payer: TriWest Medicare	$46.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$181.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.98

TSH w/ Reflex to FT4

Facility

$255.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Aetna of AZ Medicare	$71.40
Rate for Payer: AHCCCS Medicaid	$16.80
Rate for Payer: Allwell Medicaid	$16.80
Rate for Payer: Allwell Medicare	$38.25
Rate for Payer: Amerigroup Medicare	$38.25
Rate for Payer: APIPA Medicare/Medicaid	$95.24
Rate for Payer: AZCH Complete Medicaid	$16.80
Rate for Payer: AZCH Complete Medicare	$38.25
Rate for Payer: Banner UC Health Medicaid	$16.80
Rate for Payer: Banner UC Health Medicare	$38.25
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$173.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Copperpoint Commercial	$63.11
Rate for Payer: Health Net of AZ Commercial	$153.00
Rate for Payer: Health Net of AZ Medicare	$71.40
Rate for Payer: Humana of AZ Medicare	$38.25
Rate for Payer: Mercy Care Medicaid	$16.80
Rate for Payer: Self Pay Self Pay	$204.00
Rate for Payer: TriWest Medicare	$38.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.90

TSH w/ Reflex to FT4

Facility

$255.00

Service Code	CPT 84443
Hospital Charge Code	15961923
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Cash Price	$204.00
Rate for Payer: Self Pay Self Pay	$204.00

.TT Mix+TTN LC

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Cash Price	$104.00
Rate for Payer: Self Pay Self Pay	$104.00

.TT Mix+TTN LC

Facility

$130.00

Service Code	CPT 85670
Hospital Charge Code	1285818
Hospital Revenue Code	305
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna of AZ Commercial	$117.00
Rate for Payer: Aetna of AZ Medicare	$36.40
Rate for Payer: AHCCCS Medicaid	$5.77
Rate for Payer: Allwell Medicaid	$5.77
Rate for Payer: Allwell Medicare	$19.50
Rate for Payer: Amerigroup Medicare	$19.50
Rate for Payer: APIPA Medicare/Medicaid	$48.56
Rate for Payer: AZCH Complete Medicaid	$5.77
Rate for Payer: AZCH Complete Medicare	$19.50
Rate for Payer: Banner UC Health Medicaid	$5.77
Rate for Payer: Banner UC Health Medicare	$19.50
Rate for Payer: Bisbee Police All Plans	$33.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$88.40
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cigna of AZ Commercial	$84.50
Rate for Payer: Copperpoint Commercial	$32.18
Rate for Payer: Health Net of AZ Commercial	$78.00
Rate for Payer: Health Net of AZ Medicare	$36.40
Rate for Payer: Humana of AZ Medicare	$19.50
Rate for Payer: Mercy Care Medicaid	$5.77
Rate for Payer: Self Pay Self Pay	$104.00
Rate for Payer: TriWest Medicare	$19.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$75.79
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.40

T TRANSGL IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481504
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

T TRANSGL IGG

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481504
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

t-Transglutaminase (tTG) IgA LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

t-Transglutaminase (tTG) IgA LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2087656
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

t-Transglutaminase (tTG) IgG LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

t-Transglutaminase (tTG) IgG LC

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	2269437
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$388.70
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Self Pay Self Pay	$1,196.00

T TRNSGLT IGA

Facility

$1,495.00

Service Code	CPT 83516
Hospital Charge Code	22481505
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$1,345.50
Rate for Payer: Aetna of AZ Commercial	$1,345.50
Rate for Payer: Aetna of AZ Medicare	$418.60
Rate for Payer: AHCCCS Medicaid	$11.53
Rate for Payer: Allwell Medicaid	$11.53
Rate for Payer: Allwell Medicare	$224.25
Rate for Payer: Amerigroup Medicare	$224.25
Rate for Payer: APIPA Medicare/Medicaid	$558.38
Rate for Payer: AZCH Complete Medicaid	$11.53
Rate for Payer: AZCH Complete Medicare	$224.25
Rate for Payer: Banner UC Health Medicaid	$11.53
Rate for Payer: Banner UC Health Medicare	$224.25
Rate for Payer: Bisbee Police All Plans	$388.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,016.60
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cash Price	$1,196.00
Rate for Payer: Cigna of AZ Commercial	$971.75
Rate for Payer: Copperpoint Commercial	$370.01
Rate for Payer: Health Net of AZ Commercial	$897.00
Rate for Payer: Health Net of AZ Medicare	$418.60
Rate for Payer: Humana of AZ Medicare	$224.25
Rate for Payer: Mercy Care Medicaid	$11.53
Rate for Payer: Self Pay Self Pay	$1,196.00
Rate for Payer: TriWest Medicare	$224.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$871.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$269.10

Know your out-of-pocket cost for care.

All Charges