Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Aorta Duplex Complete

Facility

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$215.28
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Cash Price	$662.40
Rate for Payer: Self Pay Self Pay	$662.40

US Aorta Duplex Complete

Facility

$828.00

Service Code	CPT 76770
Hospital Charge Code	1007704
Hospital Revenue Code	402
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna of AZ Commercial	$745.20
Rate for Payer: Aetna of AZ Medicare	$231.84
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$124.20
Rate for Payer: Amerigroup Medicare	$124.20
Rate for Payer: APIPA Medicare/Medicaid	$309.26
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$124.20
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$124.20
Rate for Payer: Bisbee Police All Plans	$215.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$563.04
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cigna of AZ Commercial	$579.60
Rate for Payer: Copperpoint Commercial	$204.93
Rate for Payer: Health Net of AZ Commercial	$496.80
Rate for Payer: Health Net of AZ Medicare	$231.84
Rate for Payer: Humana of AZ Medicare	$124.20
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$662.40
Rate for Payer: TriWest Medicare	$124.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$482.72
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.04

US Aspiration Guidance

Facility

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Cash Price	$716.00
Rate for Payer: Self Pay Self Pay	$716.00

US Aspiration Guidance

Facility

$895.00

Service Code	CPT 76942
Hospital Charge Code	1007706
Hospital Revenue Code	402
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$805.50
Rate for Payer: Aetna of AZ Commercial	$805.50
Rate for Payer: Aetna of AZ Medicare	$250.60
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$134.25
Rate for Payer: Amerigroup Medicare	$134.25
Rate for Payer: APIPA Medicare/Medicaid	$334.28
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$134.25
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$134.25
Rate for Payer: Bisbee Police All Plans	$232.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$608.60
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cigna of AZ Commercial	$626.50
Rate for Payer: Copperpoint Commercial	$221.51
Rate for Payer: Health Net of AZ Commercial	$537.00
Rate for Payer: Health Net of AZ Medicare	$250.60
Rate for Payer: Humana of AZ Medicare	$134.25
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$716.00
Rate for Payer: TriWest Medicare	$134.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$521.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$161.10

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
Hospital Revenue Code	402
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Aetna of AZ Medicare	$217.84
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$116.70
Rate for Payer: Amerigroup Medicare	$116.70
Rate for Payer: APIPA Medicare/Medicaid	$290.58
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$116.70
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$116.70
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$529.04
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cigna of AZ Commercial	$544.60
Rate for Payer: Copperpoint Commercial	$192.56
Rate for Payer: Health Net of AZ Commercial	$466.80
Rate for Payer: Health Net of AZ Medicare	$217.84
Rate for Payer: Humana of AZ Medicare	$116.70
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$622.40
Rate for Payer: TriWest Medicare	$116.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$453.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$140.04

US Biopsy Needle Guided

Facility

$778.00

Service Code	CPT 76942
Hospital Charge Code	1007709
Hospital Revenue Code	402
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$700.20
Rate for Payer: Aetna of AZ Commercial	$700.20
Rate for Payer: Bisbee Police All Plans	$202.28
Rate for Payer: Cash Price	$622.40
Rate for Payer: Self Pay Self Pay	$622.40

US Breast Bilateral Complete

Facility

$993.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$258.18
Max. Negotiated Rate	$893.70
Rate for Payer: Aetna of AZ Commercial	$893.70
Rate for Payer: Bisbee Police All Plans	$258.18
Rate for Payer: Cash Price	$794.40
Rate for Payer: Self Pay Self Pay	$794.40

US Breast Bilateral Complete

Facility

$993.00

Service Code	CPT 76641 50
Hospital Charge Code	22009074
Hospital Revenue Code	402
Min. Negotiated Rate	$148.95
Max. Negotiated Rate	$893.70
Rate for Payer: Aetna of AZ Commercial	$893.70
Rate for Payer: Aetna of AZ Medicare	$278.04
Rate for Payer: Allwell Medicare	$148.95
Rate for Payer: Amerigroup Medicare	$148.95
Rate for Payer: APIPA Medicare/Medicaid	$370.89
Rate for Payer: AZCH Complete Medicare	$148.95
Rate for Payer: Banner UC Health Medicare	$148.95
Rate for Payer: Bisbee Police All Plans	$258.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$675.24
Rate for Payer: Cash Price	$794.40
Rate for Payer: Cigna of AZ Commercial	$695.10
Rate for Payer: Copperpoint Commercial	$245.77
Rate for Payer: Health Net of AZ Commercial	$595.80
Rate for Payer: Health Net of AZ Medicare	$278.04
Rate for Payer: Humana of AZ Medicare	$148.95
Rate for Payer: Self Pay Self Pay	$794.40
Rate for Payer: TriWest Medicare	$148.95
Rate for Payer: UnitedHealth Group of AZ Commercial	$578.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$178.74

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Bilateral Complete.

Facility

$845.00

Service Code	CPT 76641 50
Hospital Charge Code	22009086
Hospital Revenue Code	402
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: Allwell Medicare	$126.75
Rate for Payer: Amerigroup Medicare	$126.75
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicare	$126.75
Rate for Payer: Banner UC Health Medicare	$126.75
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$126.75
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$126.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Bilateral Limited

Facility

$746.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Bisbee Police All Plans	$193.96
Rate for Payer: Cash Price	$596.80
Rate for Payer: Self Pay Self Pay	$596.80

US Breast Bilateral Limited

Facility

$746.00

Service Code	CPT 76642 50
Hospital Charge Code	21076256
Hospital Revenue Code	402
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$671.40
Rate for Payer: Aetna of AZ Commercial	$671.40
Rate for Payer: Aetna of AZ Medicare	$208.88
Rate for Payer: Allwell Medicare	$111.90
Rate for Payer: Amerigroup Medicare	$111.90
Rate for Payer: APIPA Medicare/Medicaid	$278.63
Rate for Payer: AZCH Complete Medicare	$111.90
Rate for Payer: Banner UC Health Medicare	$111.90
Rate for Payer: Bisbee Police All Plans	$193.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$507.28
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cigna of AZ Commercial	$522.20
Rate for Payer: Copperpoint Commercial	$184.64
Rate for Payer: Health Net of AZ Commercial	$447.60
Rate for Payer: Health Net of AZ Medicare	$208.88
Rate for Payer: Humana of AZ Medicare	$111.90
Rate for Payer: Self Pay Self Pay	$596.80
Rate for Payer: TriWest Medicare	$111.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$434.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$134.28

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$208.52
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Cash Price	$641.60
Rate for Payer: Self Pay Self Pay	$641.60

US Breast Bilateral Limited.

Facility

$802.00

Service Code	CPT 76641 50
Hospital Charge Code	21231067
Hospital Revenue Code	402
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$721.80
Rate for Payer: Aetna of AZ Commercial	$721.80
Rate for Payer: Aetna of AZ Medicare	$224.56
Rate for Payer: Allwell Medicare	$120.30
Rate for Payer: Amerigroup Medicare	$120.30
Rate for Payer: APIPA Medicare/Medicaid	$299.55
Rate for Payer: AZCH Complete Medicare	$120.30
Rate for Payer: Banner UC Health Medicare	$120.30
Rate for Payer: Bisbee Police All Plans	$208.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$545.36
Rate for Payer: Cash Price	$641.60
Rate for Payer: Cigna of AZ Commercial	$561.40
Rate for Payer: Copperpoint Commercial	$198.50
Rate for Payer: Health Net of AZ Commercial	$481.20
Rate for Payer: Health Net of AZ Medicare	$224.56
Rate for Payer: Humana of AZ Medicare	$120.30
Rate for Payer: Self Pay Self Pay	$641.60
Rate for Payer: TriWest Medicare	$120.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$467.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$144.36

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$126.75
Rate for Payer: Amerigroup Medicare	$126.75
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$126.75
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$126.75
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$126.75
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$126.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Left Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009077
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Aetna of AZ Medicare	$199.92
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$107.10
Rate for Payer: Amerigroup Medicare	$107.10
Rate for Payer: APIPA Medicare/Medicaid	$266.68
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$107.10
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$107.10
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$485.52
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cigna of AZ Commercial	$499.80
Rate for Payer: Copperpoint Commercial	$176.72
Rate for Payer: Health Net of AZ Commercial	$428.40
Rate for Payer: Health Net of AZ Medicare	$199.92
Rate for Payer: Humana of AZ Medicare	$107.10
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$571.20
Rate for Payer: TriWest Medicare	$107.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$416.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.52

US Breast Left Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076259
Hospital Revenue Code	402
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Cash Price	$571.20
Rate for Payer: Self Pay Self Pay	$571.20

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Aetna of AZ Medicare	$236.60
Rate for Payer: AHCCCS Medicaid	$158.00
Rate for Payer: Allwell Medicaid	$158.00
Rate for Payer: Allwell Medicare	$126.75
Rate for Payer: Amerigroup Medicare	$126.75
Rate for Payer: APIPA Medicare/Medicaid	$315.61
Rate for Payer: AZCH Complete Medicaid	$158.00
Rate for Payer: AZCH Complete Medicare	$126.75
Rate for Payer: Banner UC Health Medicaid	$158.00
Rate for Payer: Banner UC Health Medicare	$126.75
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$574.60
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cigna of AZ Commercial	$591.50
Rate for Payer: Copperpoint Commercial	$209.14
Rate for Payer: Health Net of AZ Commercial	$507.00
Rate for Payer: Health Net of AZ Medicare	$236.60
Rate for Payer: Humana of AZ Medicare	$126.75
Rate for Payer: Mercy Care Medicaid	$158.00
Rate for Payer: Self Pay Self Pay	$676.00
Rate for Payer: TriWest Medicare	$126.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$492.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$152.10

US Breast Right Complete

Facility

$845.00

Service Code	CPT 76641
Hospital Charge Code	22009080
Hospital Revenue Code	402
Min. Negotiated Rate	$219.70
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna of AZ Commercial	$760.50
Rate for Payer: Bisbee Police All Plans	$219.70
Rate for Payer: Cash Price	$676.00
Rate for Payer: Self Pay Self Pay	$676.00

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Cash Price	$571.20
Rate for Payer: Self Pay Self Pay	$571.20

US Breast Right Limited

Facility

$714.00

Service Code	CPT 76642
Hospital Charge Code	21076262
Hospital Revenue Code	402
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$642.60
Rate for Payer: Aetna of AZ Commercial	$642.60
Rate for Payer: Aetna of AZ Medicare	$199.92
Rate for Payer: AHCCCS Medicaid	$117.30
Rate for Payer: Allwell Medicaid	$117.30
Rate for Payer: Allwell Medicare	$107.10
Rate for Payer: Amerigroup Medicare	$107.10
Rate for Payer: APIPA Medicare/Medicaid	$266.68
Rate for Payer: AZCH Complete Medicaid	$117.30
Rate for Payer: AZCH Complete Medicare	$107.10
Rate for Payer: Banner UC Health Medicaid	$117.30
Rate for Payer: Banner UC Health Medicare	$107.10
Rate for Payer: Bisbee Police All Plans	$185.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$485.52
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cigna of AZ Commercial	$499.80
Rate for Payer: Copperpoint Commercial	$176.72
Rate for Payer: Health Net of AZ Commercial	$428.40
Rate for Payer: Health Net of AZ Medicare	$199.92
Rate for Payer: Humana of AZ Medicare	$107.10
Rate for Payer: Mercy Care Medicaid	$117.30
Rate for Payer: Self Pay Self Pay	$571.20
Rate for Payer: TriWest Medicare	$107.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$416.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$128.52

US Carotid Doppler Bilateral

Facility

$1,166.00

Service Code	CPT 93880 50
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$303.16
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Bisbee Police All Plans	$303.16
Rate for Payer: Cash Price	$932.80
Rate for Payer: Self Pay Self Pay	$932.80

US Carotid Doppler Bilateral

Facility

$1,166.00

Service Code	CPT 93880 50
Hospital Charge Code	1021625
Hospital Revenue Code	921
Min. Negotiated Rate	$174.90
Max. Negotiated Rate	$1,049.40
Rate for Payer: Aetna of AZ Commercial	$1,049.40
Rate for Payer: Aetna of AZ Medicare	$326.48
Rate for Payer: Allwell Medicare	$174.90
Rate for Payer: Amerigroup Medicare	$174.90
Rate for Payer: APIPA Medicare/Medicaid	$435.50
Rate for Payer: AZCH Complete Medicare	$174.90
Rate for Payer: Banner UC Health Medicare	$174.90
Rate for Payer: Bisbee Police All Plans	$303.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$792.88
Rate for Payer: Cash Price	$932.80
Rate for Payer: Cigna of AZ Commercial	$816.20
Rate for Payer: Copperpoint Commercial	$288.58
Rate for Payer: Health Net of AZ Commercial	$699.60
Rate for Payer: Health Net of AZ Medicare	$326.48
Rate for Payer: Humana of AZ Medicare	$174.90
Rate for Payer: Self Pay Self Pay	$932.80
Rate for Payer: TriWest Medicare	$174.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$679.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$209.88

US Color Doppler

Facility

$1,444.00

Service Code	CPT 93975
Hospital Charge Code	22427825
Hospital Revenue Code	921
Min. Negotiated Rate	$216.60
Max. Negotiated Rate	$1,299.60
Rate for Payer: Aetna of AZ Commercial	$1,299.60
Rate for Payer: Aetna of AZ Medicare	$404.32
Rate for Payer: AHCCCS Medicaid	$333.68
Rate for Payer: Allwell Medicaid	$333.68
Rate for Payer: Allwell Medicare	$216.60
Rate for Payer: Amerigroup Medicare	$216.60
Rate for Payer: APIPA Medicare/Medicaid	$539.33
Rate for Payer: AZCH Complete Medicaid	$333.68
Rate for Payer: AZCH Complete Medicare	$216.60
Rate for Payer: Banner UC Health Medicaid	$333.68
Rate for Payer: Banner UC Health Medicare	$216.60
Rate for Payer: Bisbee Police All Plans	$375.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$981.92
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cash Price	$1,155.20
Rate for Payer: Cigna of AZ Commercial	$1,010.80
Rate for Payer: Copperpoint Commercial	$357.39
Rate for Payer: Health Net of AZ Commercial	$866.40
Rate for Payer: Health Net of AZ Medicare	$404.32
Rate for Payer: Humana of AZ Medicare	$216.60
Rate for Payer: Mercy Care Medicaid	$333.68
Rate for Payer: Self Pay Self Pay	$1,155.20
Rate for Payer: TriWest Medicare	$216.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$841.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$259.92

Know your out-of-pocket cost for care.

All Charges