Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

US Echocardiogram Complete

Facility

$832.00

Service Code	CPT 93320
Hospital Charge Code	1161150
Hospital Revenue Code	483
Min. Negotiated Rate	$133.12
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Aetna of AZ Medicare	$232.96
Rate for Payer: Allwell Medicare	$133.12
Rate for Payer: Amerigroup Medicare	$133.12
Rate for Payer: APIPA Medicare/Medicaid	$310.75
Rate for Payer: AZCH Complete Medicare	$133.12
Rate for Payer: Banner UC Health Medicare	$133.12
Rate for Payer: Bisbee Police All Plans	$216.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$565.76
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cigna of AZ Commercial	$582.40
Rate for Payer: Copperpoint Commercial	$205.92
Rate for Payer: Health Net of AZ Commercial	$499.20
Rate for Payer: Health Net of AZ Medicare	$232.96
Rate for Payer: Humana of AZ Medicare	$133.12
Rate for Payer: Self Pay Self Pay	$665.60
Rate for Payer: TriWest Medicare	$133.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$485.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.76

US Echocardiogram Complete

Facility

$832.00

Service Code	CPT 93320
Hospital Charge Code	1161150
Hospital Revenue Code	483
Min. Negotiated Rate	$216.32
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna of AZ Commercial	$748.80
Rate for Payer: Bisbee Police All Plans	$216.32
Rate for Payer: Cash Price	$665.60
Rate for Payer: Self Pay Self Pay	$665.60

US ECHO Complete

Facility

$2,486.00

Service Code	CPT 93306
Hospital Charge Code	10443714
Hospital Revenue Code	483
Min. Negotiated Rate	$350.10
Max. Negotiated Rate	$2,237.40
Rate for Payer: Aetna of AZ Commercial	$2,237.40
Rate for Payer: Aetna of AZ Medicare	$696.08
Rate for Payer: AHCCCS Medicaid	$350.10
Rate for Payer: Allwell Medicaid	$350.10
Rate for Payer: Allwell Medicare	$397.76
Rate for Payer: Amerigroup Medicare	$397.76
Rate for Payer: APIPA Medicare/Medicaid	$928.52
Rate for Payer: AZCH Complete Medicaid	$350.10
Rate for Payer: AZCH Complete Medicare	$397.76
Rate for Payer: Banner UC Health Medicaid	$350.10
Rate for Payer: Banner UC Health Medicare	$397.76
Rate for Payer: Bisbee Police All Plans	$646.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,690.48
Rate for Payer: Cash Price	$1,988.80
Rate for Payer: Cash Price	$1,988.80
Rate for Payer: Cigna of AZ Commercial	$1,740.20
Rate for Payer: Copperpoint Commercial	$615.28
Rate for Payer: Health Net of AZ Commercial	$1,491.60
Rate for Payer: Health Net of AZ Medicare	$696.08
Rate for Payer: Humana of AZ Medicare	$397.76
Rate for Payer: Mercy Care Medicaid	$350.10
Rate for Payer: Self Pay Self Pay	$1,988.80
Rate for Payer: TriWest Medicare	$397.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,449.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$447.48

US ECHO Complete

Facility

$2,486.00

Service Code	CPT 93306
Hospital Charge Code	10443714
Hospital Revenue Code	483
Min. Negotiated Rate	$646.36
Max. Negotiated Rate	$2,237.40
Rate for Payer: Aetna of AZ Commercial	$2,237.40
Rate for Payer: Bisbee Police All Plans	$646.36
Rate for Payer: Cash Price	$1,988.80
Rate for Payer: Self Pay Self Pay	$1,988.80

US ECHOGR Transrectal

Facility

$833.00

Service Code	CPT 76872
Hospital Charge Code	22577967
Hospital Revenue Code	402
Min. Negotiated Rate	$216.58
Max. Negotiated Rate	$749.70
Rate for Payer: Aetna of AZ Commercial	$749.70
Rate for Payer: Bisbee Police All Plans	$216.58
Rate for Payer: Cash Price	$666.40
Rate for Payer: Self Pay Self Pay	$666.40

US ECHOGR Transrectal

Facility

$833.00

Service Code	CPT 76872
Hospital Charge Code	22577967
Hospital Revenue Code	402
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$749.70
Rate for Payer: Aetna of AZ Commercial	$749.70
Rate for Payer: Aetna of AZ Medicare	$233.24
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$133.28
Rate for Payer: Amerigroup Medicare	$133.28
Rate for Payer: APIPA Medicare/Medicaid	$311.13
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$133.28
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$133.28
Rate for Payer: Bisbee Police All Plans	$216.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$566.44
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cigna of AZ Commercial	$583.10
Rate for Payer: Copperpoint Commercial	$206.17
Rate for Payer: Health Net of AZ Commercial	$499.80
Rate for Payer: Health Net of AZ Medicare	$233.24
Rate for Payer: Humana of AZ Medicare	$133.28
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$666.40
Rate for Payer: TriWest Medicare	$133.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$485.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$149.94

US Fetal Biophysical Profile

Facility

$919.00

Service Code	CPT 76818
Hospital Charge Code	1007763
Hospital Revenue Code	402
Min. Negotiated Rate	$238.94
Max. Negotiated Rate	$827.10
Rate for Payer: Aetna of AZ Commercial	$827.10
Rate for Payer: Bisbee Police All Plans	$238.94
Rate for Payer: Cash Price	$735.20
Rate for Payer: Self Pay Self Pay	$735.20

US Fetal Biophysical Profile

Facility

$919.00

Service Code	CPT 76818
Hospital Charge Code	1007763
Hospital Revenue Code	402
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$827.10
Rate for Payer: Aetna of AZ Commercial	$827.10
Rate for Payer: Aetna of AZ Medicare	$257.32
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$147.04
Rate for Payer: Amerigroup Medicare	$147.04
Rate for Payer: APIPA Medicare/Medicaid	$343.25
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$147.04
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$147.04
Rate for Payer: Bisbee Police All Plans	$238.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$624.92
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cash Price	$735.20
Rate for Payer: Cigna of AZ Commercial	$643.30
Rate for Payer: Copperpoint Commercial	$227.45
Rate for Payer: Health Net of AZ Commercial	$551.40
Rate for Payer: Health Net of AZ Medicare	$257.32
Rate for Payer: Humana of AZ Medicare	$147.04
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$735.20
Rate for Payer: TriWest Medicare	$147.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$535.78
Rate for Payer: UnitedHealth Group of AZ Medicare	$165.42

US Fetal Eval Complete

Facility

$816.00

Service Code	CPT 76815
Hospital Charge Code	1007766
Hospital Revenue Code	402
Min. Negotiated Rate	$212.16
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of AZ Commercial	$734.40
Rate for Payer: Bisbee Police All Plans	$212.16
Rate for Payer: Cash Price	$652.80
Rate for Payer: Self Pay Self Pay	$652.80

US Fetal Eval Complete

Facility

$816.00

Service Code	CPT 76815
Hospital Charge Code	1007766
Hospital Revenue Code	402
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$734.40
Rate for Payer: Aetna of AZ Commercial	$734.40
Rate for Payer: Aetna of AZ Medicare	$228.48
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$130.56
Rate for Payer: Amerigroup Medicare	$130.56
Rate for Payer: APIPA Medicare/Medicaid	$304.78
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$130.56
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$130.56
Rate for Payer: Bisbee Police All Plans	$212.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$554.88
Rate for Payer: Cash Price	$652.80
Rate for Payer: Cash Price	$652.80
Rate for Payer: Cigna of AZ Commercial	$571.20
Rate for Payer: Copperpoint Commercial	$201.96
Rate for Payer: Health Net of AZ Commercial	$489.60
Rate for Payer: Health Net of AZ Medicare	$228.48
Rate for Payer: Humana of AZ Medicare	$130.56
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$652.80
Rate for Payer: TriWest Medicare	$130.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$475.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$146.88

US Gallbladder

Facility

$1,232.00

Service Code	CPT 76700
Hospital Charge Code	2214185
Hospital Revenue Code	402
Min. Negotiated Rate	$320.32
Max. Negotiated Rate	$1,108.80
Rate for Payer: Aetna of AZ Commercial	$1,108.80
Rate for Payer: Bisbee Police All Plans	$320.32
Rate for Payer: Cash Price	$985.60
Rate for Payer: Self Pay Self Pay	$985.60

US Gallbladder

Facility

$1,232.00

Service Code	CPT 76700
Hospital Charge Code	2214185
Hospital Revenue Code	402
Min. Negotiated Rate	$197.12
Max. Negotiated Rate	$1,108.80
Rate for Payer: Aetna of AZ Commercial	$1,108.80
Rate for Payer: Aetna of AZ Medicare	$344.96
Rate for Payer: Allwell Medicare	$197.12
Rate for Payer: Amerigroup Medicare	$197.12
Rate for Payer: APIPA Medicare/Medicaid	$460.15
Rate for Payer: AZCH Complete Medicare	$197.12
Rate for Payer: Banner UC Health Medicare	$197.12
Rate for Payer: Bisbee Police All Plans	$320.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$837.76
Rate for Payer: Cash Price	$985.60
Rate for Payer: Cigna of AZ Commercial	$862.40
Rate for Payer: Copperpoint Commercial	$304.92
Rate for Payer: Health Net of AZ Commercial	$739.20
Rate for Payer: Health Net of AZ Medicare	$344.96
Rate for Payer: Humana of AZ Medicare	$197.12
Rate for Payer: Self Pay Self Pay	$985.60
Rate for Payer: TriWest Medicare	$197.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$718.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$221.76

US Guided Liver Biopsy

Facility

$876.00

Service Code	CPT 76942
Hospital Charge Code	1163747
Hospital Revenue Code	402
Min. Negotiated Rate	$227.76
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Bisbee Police All Plans	$227.76
Rate for Payer: Cash Price	$700.80
Rate for Payer: Self Pay Self Pay	$700.80

US Guided Liver Biopsy

Facility

$876.00

Service Code	CPT 76942
Hospital Charge Code	1163747
Hospital Revenue Code	402
Min. Negotiated Rate	$140.16
Max. Negotiated Rate	$788.40
Rate for Payer: Aetna of AZ Commercial	$788.40
Rate for Payer: Aetna of AZ Medicare	$245.28
Rate for Payer: Allwell Medicare	$140.16
Rate for Payer: Amerigroup Medicare	$140.16
Rate for Payer: APIPA Medicare/Medicaid	$327.19
Rate for Payer: AZCH Complete Medicare	$140.16
Rate for Payer: Banner UC Health Medicare	$140.16
Rate for Payer: Bisbee Police All Plans	$227.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$595.68
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cigna of AZ Commercial	$613.20
Rate for Payer: Copperpoint Commercial	$216.81
Rate for Payer: Health Net of AZ Commercial	$525.60
Rate for Payer: Health Net of AZ Medicare	$245.28
Rate for Payer: Humana of AZ Medicare	$140.16
Rate for Payer: Self Pay Self Pay	$700.80
Rate for Payer: TriWest Medicare	$140.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$510.71
Rate for Payer: UnitedHealth Group of AZ Medicare	$157.68

US Guided Lung Biopsy

Facility

$681.00

Service Code	CPT 76942
Hospital Charge Code	1163750
Hospital Revenue Code	402
Min. Negotiated Rate	$177.06
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Bisbee Police All Plans	$177.06
Rate for Payer: Cash Price	$544.80
Rate for Payer: Self Pay Self Pay	$544.80

US Guided Lung Biopsy

Facility

$681.00

Service Code	CPT 76942
Hospital Charge Code	1163750
Hospital Revenue Code	402
Min. Negotiated Rate	$108.96
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Aetna of AZ Medicare	$190.68
Rate for Payer: Allwell Medicare	$108.96
Rate for Payer: Amerigroup Medicare	$108.96
Rate for Payer: APIPA Medicare/Medicaid	$254.35
Rate for Payer: AZCH Complete Medicare	$108.96
Rate for Payer: Banner UC Health Medicare	$108.96
Rate for Payer: Bisbee Police All Plans	$177.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$463.08
Rate for Payer: Cash Price	$544.80
Rate for Payer: Cigna of AZ Commercial	$476.70
Rate for Payer: Copperpoint Commercial	$168.55
Rate for Payer: Health Net of AZ Commercial	$408.60
Rate for Payer: Health Net of AZ Medicare	$190.68
Rate for Payer: Humana of AZ Medicare	$108.96
Rate for Payer: Self Pay Self Pay	$544.80
Rate for Payer: TriWest Medicare	$108.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$397.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.58

US Head/Neck Soft Tissue

Facility

$938.00

Service Code	CPT 76536
Hospital Charge Code	823428
Hospital Revenue Code	402
Min. Negotiated Rate	$243.88
Max. Negotiated Rate	$844.20
Rate for Payer: Aetna of AZ Commercial	$844.20
Rate for Payer: Bisbee Police All Plans	$243.88
Rate for Payer: Cash Price	$750.40
Rate for Payer: Self Pay Self Pay	$750.40

US Head/Neck Soft Tissue

Facility

$938.00

Service Code	CPT 76536
Hospital Charge Code	823428
Hospital Revenue Code	402
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$844.20
Rate for Payer: Aetna of AZ Commercial	$844.20
Rate for Payer: Aetna of AZ Medicare	$262.64
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$150.08
Rate for Payer: Amerigroup Medicare	$150.08
Rate for Payer: APIPA Medicare/Medicaid	$350.34
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$150.08
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$150.08
Rate for Payer: Bisbee Police All Plans	$243.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$637.84
Rate for Payer: Cash Price	$750.40
Rate for Payer: Cash Price	$750.40
Rate for Payer: Cigna of AZ Commercial	$656.60
Rate for Payer: Copperpoint Commercial	$232.16
Rate for Payer: Health Net of AZ Commercial	$562.80
Rate for Payer: Health Net of AZ Medicare	$262.64
Rate for Payer: Humana of AZ Medicare	$150.08
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$750.40
Rate for Payer: TriWest Medicare	$150.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$546.85
Rate for Payer: UnitedHealth Group of AZ Medicare	$168.84

US LE Arterial Duplex Bilateral

Facility

$2,047.00

Service Code	CPT 93925
Hospital Charge Code	823436
Hospital Revenue Code	921
Min. Negotiated Rate	$166.84
Max. Negotiated Rate	$1,842.30
Rate for Payer: Aetna of AZ Commercial	$1,842.30
Rate for Payer: Aetna of AZ Medicare	$573.16
Rate for Payer: AHCCCS Medicaid	$166.84
Rate for Payer: Allwell Medicaid	$166.84
Rate for Payer: Allwell Medicare	$327.52
Rate for Payer: Amerigroup Medicare	$327.52
Rate for Payer: APIPA Medicare/Medicaid	$764.55
Rate for Payer: AZCH Complete Medicaid	$166.84
Rate for Payer: AZCH Complete Medicare	$327.52
Rate for Payer: Banner UC Health Medicaid	$166.84
Rate for Payer: Banner UC Health Medicare	$327.52
Rate for Payer: Bisbee Police All Plans	$532.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,391.96
Rate for Payer: Cash Price	$1,637.60
Rate for Payer: Cash Price	$1,637.60
Rate for Payer: Cigna of AZ Commercial	$1,432.90
Rate for Payer: Copperpoint Commercial	$506.63
Rate for Payer: Health Net of AZ Commercial	$1,228.20
Rate for Payer: Health Net of AZ Medicare	$573.16
Rate for Payer: Humana of AZ Medicare	$327.52
Rate for Payer: Mercy Care Medicaid	$166.84
Rate for Payer: Self Pay Self Pay	$1,637.60
Rate for Payer: TriWest Medicare	$327.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,193.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$368.46

US LE Arterial Duplex Bilateral

Facility

$2,047.00

Service Code	CPT 93925
Hospital Charge Code	823436
Hospital Revenue Code	921
Min. Negotiated Rate	$532.22
Max. Negotiated Rate	$1,842.30
Rate for Payer: Aetna of AZ Commercial	$1,842.30
Rate for Payer: Bisbee Police All Plans	$532.22
Rate for Payer: Cash Price	$1,637.60
Rate for Payer: Self Pay Self Pay	$1,637.60

US LE Arterial Duplex Left

Facility

$1,164.00

Service Code	CPT 93926
Hospital Charge Code	823438
Hospital Revenue Code	921
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$1,047.60
Rate for Payer: Aetna of AZ Commercial	$1,047.60
Rate for Payer: Aetna of AZ Medicare	$325.92
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$186.24
Rate for Payer: Amerigroup Medicare	$186.24
Rate for Payer: APIPA Medicare/Medicaid	$434.75
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$186.24
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$186.24
Rate for Payer: Bisbee Police All Plans	$302.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$791.52
Rate for Payer: Cash Price	$931.20
Rate for Payer: Cash Price	$931.20
Rate for Payer: Cigna of AZ Commercial	$814.80
Rate for Payer: Copperpoint Commercial	$288.09
Rate for Payer: Health Net of AZ Commercial	$698.40
Rate for Payer: Health Net of AZ Medicare	$325.92
Rate for Payer: Humana of AZ Medicare	$186.24
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$931.20
Rate for Payer: TriWest Medicare	$186.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$678.61
Rate for Payer: UnitedHealth Group of AZ Medicare	$209.52

US LE Arterial Duplex Left

Facility

$1,164.00

Service Code	CPT 93926
Hospital Charge Code	823438
Hospital Revenue Code	921
Min. Negotiated Rate	$302.64
Max. Negotiated Rate	$1,047.60
Rate for Payer: Aetna of AZ Commercial	$1,047.60
Rate for Payer: Bisbee Police All Plans	$302.64
Rate for Payer: Cash Price	$931.20
Rate for Payer: Self Pay Self Pay	$931.20

US LE Arterial Duplex Right

Facility

$862.00

Service Code	CPT 93926
Hospital Charge Code	823440
Hospital Revenue Code	921
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Aetna of AZ Medicare	$241.36
Rate for Payer: AHCCCS Medicaid	$79.00
Rate for Payer: Allwell Medicaid	$79.00
Rate for Payer: Allwell Medicare	$137.92
Rate for Payer: Amerigroup Medicare	$137.92
Rate for Payer: APIPA Medicare/Medicaid	$321.96
Rate for Payer: AZCH Complete Medicaid	$79.00
Rate for Payer: AZCH Complete Medicare	$137.92
Rate for Payer: Banner UC Health Medicaid	$79.00
Rate for Payer: Banner UC Health Medicare	$137.92
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$586.16
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cigna of AZ Commercial	$603.40
Rate for Payer: Copperpoint Commercial	$213.34
Rate for Payer: Health Net of AZ Commercial	$517.20
Rate for Payer: Health Net of AZ Medicare	$241.36
Rate for Payer: Humana of AZ Medicare	$137.92
Rate for Payer: Mercy Care Medicaid	$79.00
Rate for Payer: Self Pay Self Pay	$689.60
Rate for Payer: TriWest Medicare	$137.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$502.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$155.16

US LE Arterial Duplex Right

Facility

$862.00

Service Code	CPT 93926
Hospital Charge Code	823440
Hospital Revenue Code	921
Min. Negotiated Rate	$224.12
Max. Negotiated Rate	$775.80
Rate for Payer: Aetna of AZ Commercial	$775.80
Rate for Payer: Bisbee Police All Plans	$224.12
Rate for Payer: Cash Price	$689.60
Rate for Payer: Self Pay Self Pay	$689.60

US LE Venous Duplex Bilateral

Facility

$1,728.00

Service Code	CPT 93970
Hospital Charge Code	823442
Hospital Revenue Code	921
Min. Negotiated Rate	$449.28
Max. Negotiated Rate	$1,555.20
Rate for Payer: Aetna of AZ Commercial	$1,555.20
Rate for Payer: Bisbee Police All Plans	$449.28
Rate for Payer: Cash Price	$1,382.40
Rate for Payer: Self Pay Self Pay	$1,382.40

Know your out-of-pocket cost for care.

All Charges