Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

TUBING BUBBLE

Facility

$49.00

Service Code	CPT 36000
Hospital Charge Code	22355703
Hospital Revenue Code	270
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna of AZ Commercial	$44.10
Rate for Payer: Bisbee Police All Plans	$12.74
Rate for Payer: Cash Price	$39.20
Rate for Payer: Self Pay Self Pay	$39.20

TUBING VENTILATOR

Facility

$31.44

Hospital Charge Code	22355102
Hospital Revenue Code	271
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna of AZ Commercial	$28.30
Rate for Payer: Bisbee Police All Plans	$8.17
Rate for Payer: Cash Price	$25.15
Rate for Payer: Self Pay Self Pay	$25.15

TUBING VENTILATOR

Facility

$31.44

Hospital Charge Code	22355102
Hospital Revenue Code	271
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna of AZ Commercial	$28.30
Rate for Payer: Aetna of AZ Medicare	$8.80
Rate for Payer: Allwell Medicare	$4.72
Rate for Payer: Amerigroup Medicare	$4.72
Rate for Payer: APIPA Medicare/Medicaid	$11.74
Rate for Payer: AZCH Complete Medicare	$4.72
Rate for Payer: Banner UC Health Medicare	$4.72
Rate for Payer: Bisbee Police All Plans	$8.17
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$21.38
Rate for Payer: Cash Price	$25.15
Rate for Payer: Cigna of AZ Commercial	$22.01
Rate for Payer: Copperpoint Commercial	$7.78
Rate for Payer: Health Net of AZ Commercial	$18.86
Rate for Payer: Health Net of AZ Medicare	$8.80
Rate for Payer: Humana of AZ Medicare	$4.72
Rate for Payer: Self Pay Self Pay	$25.15
Rate for Payer: TriWest Medicare	$4.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$18.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$5.66

TUMOR IMMUNOHISTOCHEM/MANUAL

Facility

$422.00

Service Code	CPT 88360
Hospital Charge Code	22545741
Hospital Revenue Code	310
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna of AZ Commercial	$379.80
Rate for Payer: Bisbee Police All Plans	$109.72
Rate for Payer: Cash Price	$337.60
Rate for Payer: Self Pay Self Pay	$337.60

TUMOR IMMUNOHISTOCHEM/MANUAL

Facility

$422.00

Service Code	CPT 88360
Hospital Charge Code	22545741
Hospital Revenue Code	310
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna of AZ Commercial	$379.80
Rate for Payer: Aetna of AZ Medicare	$118.16
Rate for Payer: AHCCCS Medicaid	$108.14
Rate for Payer: Allwell Medicaid	$108.14
Rate for Payer: Allwell Medicare	$63.30
Rate for Payer: Amerigroup Medicare	$63.30
Rate for Payer: APIPA Medicare/Medicaid	$157.62
Rate for Payer: AZCH Complete Medicaid	$108.14
Rate for Payer: AZCH Complete Medicare	$63.30
Rate for Payer: Banner UC Health Medicaid	$108.14
Rate for Payer: Banner UC Health Medicare	$63.30
Rate for Payer: Bisbee Police All Plans	$109.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$286.96
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cigna of AZ Commercial	$274.30
Rate for Payer: Copperpoint Commercial	$104.44
Rate for Payer: Health Net of AZ Commercial	$253.20
Rate for Payer: Health Net of AZ Medicare	$118.16
Rate for Payer: Humana of AZ Medicare	$63.30
Rate for Payer: Mercy Care Medicaid	$108.14
Rate for Payer: Self Pay Self Pay	$337.60
Rate for Payer: TriWest Medicare	$63.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$246.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$75.96

TVH/BSO

Facility

$5,056.00

Service Code	CPT 58262
Hospital Charge Code	27281886
Hospital Revenue Code	360
Min. Negotiated Rate	$758.40
Max. Negotiated Rate	$6,393.84
Rate for Payer: Aetna of AZ Commercial	$4,550.40
Rate for Payer: Aetna of AZ Medicare	$1,415.68
Rate for Payer: AHCCCS Medicaid	$6,393.84
Rate for Payer: Allwell Medicaid	$6,393.84
Rate for Payer: Allwell Medicare	$758.40
Rate for Payer: Amerigroup Medicare	$758.40
Rate for Payer: APIPA Medicare/Medicaid	$1,888.42
Rate for Payer: AZCH Complete Medicaid	$6,393.84
Rate for Payer: AZCH Complete Medicare	$758.40
Rate for Payer: Banner UC Health Medicaid	$6,393.84
Rate for Payer: Banner UC Health Medicare	$758.40
Rate for Payer: Bisbee Police All Plans	$1,314.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,438.08
Rate for Payer: Cash Price	$4,044.80
Rate for Payer: Cash Price	$4,044.80
Rate for Payer: Cigna of AZ Commercial	$2,528.00
Rate for Payer: Copperpoint Commercial	$1,251.36
Rate for Payer: Health Net of AZ Commercial	$3,033.60
Rate for Payer: Health Net of AZ Medicare	$1,415.68
Rate for Payer: Humana of AZ Medicare	$758.40
Rate for Payer: Mercy Care Medicaid	$6,393.84
Rate for Payer: Self Pay Self Pay	$4,044.80
Rate for Payer: TriWest Medicare	$758.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$910.08

TVH/BSO

Facility

$5,056.00

Service Code	CPT 58262
Hospital Charge Code	27281886
Hospital Revenue Code	360
Min. Negotiated Rate	$1,314.56
Max. Negotiated Rate	$4,550.40
Rate for Payer: Aetna of AZ Commercial	$4,550.40
Rate for Payer: Bisbee Police All Plans	$1,314.56
Rate for Payer: Cash Price	$4,044.80
Rate for Payer: Self Pay Self Pay	$4,044.80

TVH/BSO w/enterocele

Facility

$4,877.00

Service Code	CPT 58270
Hospital Charge Code	27281887
Hospital Revenue Code	360
Min. Negotiated Rate	$1,268.02
Max. Negotiated Rate	$4,389.30
Rate for Payer: Aetna of AZ Commercial	$4,389.30
Rate for Payer: Bisbee Police All Plans	$1,268.02
Rate for Payer: Cash Price	$3,901.60
Rate for Payer: Self Pay Self Pay	$3,901.60

TVH/BSO w/enterocele

Facility

$4,877.00

Service Code	CPT 58270
Hospital Charge Code	27281887
Hospital Revenue Code	360
Min. Negotiated Rate	$731.55
Max. Negotiated Rate	$6,393.84
Rate for Payer: Aetna of AZ Commercial	$4,389.30
Rate for Payer: Aetna of AZ Medicare	$1,365.56
Rate for Payer: AHCCCS Medicaid	$6,393.84
Rate for Payer: Allwell Medicaid	$6,393.84
Rate for Payer: Allwell Medicare	$731.55
Rate for Payer: Amerigroup Medicare	$731.55
Rate for Payer: APIPA Medicare/Medicaid	$1,821.56
Rate for Payer: AZCH Complete Medicaid	$6,393.84
Rate for Payer: AZCH Complete Medicare	$731.55
Rate for Payer: Banner UC Health Medicaid	$6,393.84
Rate for Payer: Banner UC Health Medicare	$731.55
Rate for Payer: Bisbee Police All Plans	$1,268.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,316.36
Rate for Payer: Cash Price	$3,901.60
Rate for Payer: Cash Price	$3,901.60
Rate for Payer: Cigna of AZ Commercial	$2,438.50
Rate for Payer: Copperpoint Commercial	$1,207.06
Rate for Payer: Health Net of AZ Commercial	$2,926.20
Rate for Payer: Health Net of AZ Medicare	$1,365.56
Rate for Payer: Humana of AZ Medicare	$731.55
Rate for Payer: Mercy Care Medicaid	$6,393.84
Rate for Payer: Self Pay Self Pay	$3,901.60
Rate for Payer: TriWest Medicare	$731.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$877.86

TVH w/vaginectomy (colpocleisis)

Facility

$5,402.00

Service Code	CPT 58275
Hospital Charge Code	27281888
Hospital Revenue Code	360
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$4,861.80
Rate for Payer: Aetna of AZ Commercial	$4,861.80
Rate for Payer: Aetna of AZ Medicare	$1,512.56
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$810.30
Rate for Payer: Amerigroup Medicare	$810.30
Rate for Payer: APIPA Medicare/Medicaid	$2,017.65
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$810.30
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$810.30
Rate for Payer: Bisbee Police All Plans	$1,404.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,673.36
Rate for Payer: Cash Price	$4,321.60
Rate for Payer: Cash Price	$4,321.60
Rate for Payer: Cigna of AZ Commercial	$2,701.00
Rate for Payer: Copperpoint Commercial	$1,337.00
Rate for Payer: Health Net of AZ Commercial	$3,241.20
Rate for Payer: Health Net of AZ Medicare	$1,512.56
Rate for Payer: Humana of AZ Medicare	$810.30
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$4,321.60
Rate for Payer: TriWest Medicare	$810.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$972.36

TVH w/vaginectomy (colpocleisis)

Facility

$5,402.00

Service Code	CPT 58275
Hospital Charge Code	27281888
Hospital Revenue Code	360
Min. Negotiated Rate	$1,404.52
Max. Negotiated Rate	$4,861.80
Rate for Payer: Aetna of AZ Commercial	$4,861.80
Rate for Payer: Bisbee Police All Plans	$1,404.52
Rate for Payer: Cash Price	$4,321.60
Rate for Payer: Self Pay Self Pay	$4,321.60

TWIN CATH 18/20 MULT-LUMEN PERIPH CATH

Facility

$103.00

Hospital Charge Code	22355400
Hospital Revenue Code	270
Min. Negotiated Rate	$26.78
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of AZ Commercial	$92.70
Rate for Payer: Bisbee Police All Plans	$26.78
Rate for Payer: Cash Price	$82.40
Rate for Payer: Self Pay Self Pay	$82.40

TWIN CATH 18/20 MULT-LUMEN PERIPH CATH

Facility

$103.00

Hospital Charge Code	22355400
Hospital Revenue Code	270
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$92.70
Rate for Payer: Aetna of AZ Commercial	$92.70
Rate for Payer: Aetna of AZ Medicare	$28.84
Rate for Payer: Allwell Medicare	$15.45
Rate for Payer: Amerigroup Medicare	$15.45
Rate for Payer: APIPA Medicare/Medicaid	$38.47
Rate for Payer: AZCH Complete Medicare	$15.45
Rate for Payer: Banner UC Health Medicare	$15.45
Rate for Payer: Bisbee Police All Plans	$26.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.04
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cigna of AZ Commercial	$72.10
Rate for Payer: Copperpoint Commercial	$25.49
Rate for Payer: Health Net of AZ Commercial	$61.80
Rate for Payer: Health Net of AZ Medicare	$28.84
Rate for Payer: Humana of AZ Medicare	$15.45
Rate for Payer: Self Pay Self Pay	$82.40
Rate for Payer: TriWest Medicare	$15.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.54

TWIN-CATH 20/22 MULT-LUMEN PERIPH CATH

Facility

$104.00

Hospital Charge Code	22355399
Hospital Revenue Code	270
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Cash Price	$83.20
Rate for Payer: Self Pay Self Pay	$83.20

TWIN-CATH 20/22 MULT-LUMEN PERIPH CATH

Facility

$104.00

Hospital Charge Code	22355399
Hospital Revenue Code	270
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna of AZ Commercial	$93.60
Rate for Payer: Aetna of AZ Medicare	$29.12
Rate for Payer: Allwell Medicare	$15.60
Rate for Payer: Amerigroup Medicare	$15.60
Rate for Payer: APIPA Medicare/Medicaid	$38.84
Rate for Payer: AZCH Complete Medicare	$15.60
Rate for Payer: Banner UC Health Medicare	$15.60
Rate for Payer: Bisbee Police All Plans	$27.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$70.72
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$25.74
Rate for Payer: Health Net of AZ Commercial	$62.40
Rate for Payer: Health Net of AZ Medicare	$29.12
Rate for Payer: Humana of AZ Medicare	$15.60
Rate for Payer: Self Pay Self Pay	$83.20
Rate for Payer: TriWest Medicare	$15.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$60.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.72

U24 Microalbumin/Creat

Facility

$137.00

Service Code	CPT 82043
Hospital Charge Code	1279989
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of AZ Commercial	$123.30
Rate for Payer: Aetna of AZ Medicare	$38.36
Rate for Payer: AHCCCS Medicaid	$5.78
Rate for Payer: Allwell Medicaid	$5.78
Rate for Payer: Allwell Medicare	$20.55
Rate for Payer: Amerigroup Medicare	$20.55
Rate for Payer: APIPA Medicare/Medicaid	$51.17
Rate for Payer: AZCH Complete Medicaid	$5.78
Rate for Payer: AZCH Complete Medicare	$20.55
Rate for Payer: Banner UC Health Medicaid	$5.78
Rate for Payer: Banner UC Health Medicare	$20.55
Rate for Payer: Bisbee Police All Plans	$35.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$93.16
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cigna of AZ Commercial	$89.05
Rate for Payer: Copperpoint Commercial	$33.91
Rate for Payer: Health Net of AZ Commercial	$82.20
Rate for Payer: Health Net of AZ Medicare	$38.36
Rate for Payer: Humana of AZ Medicare	$20.55
Rate for Payer: Mercy Care Medicaid	$5.78
Rate for Payer: Self Pay Self Pay	$109.60
Rate for Payer: TriWest Medicare	$20.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$79.87
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.66

U24 Microalbumin/Creat

Facility

$137.00

Service Code	CPT 82043
Hospital Charge Code	1279989
Hospital Revenue Code	301
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$123.30
Rate for Payer: Aetna of AZ Commercial	$123.30
Rate for Payer: Bisbee Police All Plans	$35.62
Rate for Payer: Cash Price	$109.60
Rate for Payer: Self Pay Self Pay	$109.60

UA Micro Standard

Facility

$39.00

Service Code	CPT 81015
Hospital Charge Code	22207838
Hospital Revenue Code	307
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Aetna of AZ Medicare	$10.92
Rate for Payer: AHCCCS Medicaid	$3.05
Rate for Payer: Allwell Medicaid	$3.05
Rate for Payer: Allwell Medicare	$5.85
Rate for Payer: Amerigroup Medicare	$5.85
Rate for Payer: APIPA Medicare/Medicaid	$14.57
Rate for Payer: AZCH Complete Medicaid	$3.05
Rate for Payer: AZCH Complete Medicare	$5.85
Rate for Payer: Banner UC Health Medicaid	$3.05
Rate for Payer: Banner UC Health Medicare	$5.85
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$26.52
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cigna of AZ Commercial	$25.35
Rate for Payer: Copperpoint Commercial	$9.65
Rate for Payer: Health Net of AZ Commercial	$23.40
Rate for Payer: Health Net of AZ Medicare	$10.92
Rate for Payer: Humana of AZ Medicare	$5.85
Rate for Payer: Mercy Care Medicaid	$3.05
Rate for Payer: Self Pay Self Pay	$31.20
Rate for Payer: TriWest Medicare	$5.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$22.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.02

UA Micro Standard

Facility

$39.00

Service Code	CPT 81015
Hospital Charge Code	22207838
Hospital Revenue Code	307
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna of AZ Commercial	$35.10
Rate for Payer: Bisbee Police All Plans	$10.14
Rate for Payer: Cash Price	$31.20
Rate for Payer: Self Pay Self Pay	$31.20

UA/M w/rflx Culture, Routine LC

Facility

$84.00

Service Code	CPT 81001
Hospital Charge Code	22311208
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: AHCCCS Medicaid	$3.17
Rate for Payer: Allwell Medicaid	$3.17
Rate for Payer: Allwell Medicare	$12.60
Rate for Payer: Amerigroup Medicare	$12.60
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicaid	$3.17
Rate for Payer: AZCH Complete Medicare	$12.60
Rate for Payer: Banner UC Health Medicaid	$3.17
Rate for Payer: Banner UC Health Medicare	$12.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$12.60
Rate for Payer: Mercy Care Medicaid	$3.17
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$12.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

UA/M w/rflx Culture, Routine LC

Facility

$84.00

Service Code	CPT 81001
Hospital Charge Code	22311208
Hospital Revenue Code	307
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

ULTRASOUND NEEDLE 21G X 3 IN

Facility

$58.00

Hospital Charge Code	27554884
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Aetna of AZ Medicare	$16.24
Rate for Payer: Allwell Medicare	$8.70
Rate for Payer: Amerigroup Medicare	$8.70
Rate for Payer: APIPA Medicare/Medicaid	$21.66
Rate for Payer: AZCH Complete Medicare	$8.70
Rate for Payer: Banner UC Health Medicare	$8.70
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$39.44
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cigna of AZ Commercial	$40.60
Rate for Payer: Copperpoint Commercial	$14.36
Rate for Payer: Health Net of AZ Commercial	$34.80
Rate for Payer: Health Net of AZ Medicare	$16.24
Rate for Payer: Humana of AZ Medicare	$8.70
Rate for Payer: Self Pay Self Pay	$46.40
Rate for Payer: TriWest Medicare	$8.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$33.81
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.44

ULTRASOUND NEEDLE 21G X 3 IN

Facility

$58.00

Hospital Charge Code	27554884
Hospital Revenue Code	270
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna of AZ Commercial	$52.20
Rate for Payer: Bisbee Police All Plans	$15.08
Rate for Payer: Cash Price	$46.40
Rate for Payer: Self Pay Self Pay	$46.40

ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22282742
Hospital Revenue Code	402
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna of AZ Commercial	$756.00
Rate for Payer: Bisbee Police All Plans	$218.40
Rate for Payer: Cash Price	$672.00
Rate for Payer: Self Pay Self Pay	$672.00

ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY

Facility

$840.00

Service Code	CPT 76981
Hospital Charge Code	22282742
Hospital Revenue Code	402
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna of AZ Commercial	$756.00
Rate for Payer: Aetna of AZ Medicare	$235.20
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$126.00
Rate for Payer: Amerigroup Medicare	$126.00
Rate for Payer: APIPA Medicare/Medicaid	$313.74
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$126.00
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$126.00
Rate for Payer: Bisbee Police All Plans	$218.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$571.20
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cigna of AZ Commercial	$588.00
Rate for Payer: Copperpoint Commercial	$207.90
Rate for Payer: Health Net of AZ Commercial	$504.00
Rate for Payer: Health Net of AZ Medicare	$235.20
Rate for Payer: Humana of AZ Medicare	$126.00
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$672.00
Rate for Payer: TriWest Medicare	$126.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$489.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$151.20

Know your out-of-pocket cost for care.

All Charges