Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Aph Plt ACDA LR 3

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857741
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857748
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857748
Hospital Revenue Code	390
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$469.78
Rate for Payer: Allwell Medicaid	$469.78
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$469.78
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$469.78
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$469.78
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$947.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Aph Plt ACDA LR Irr 1

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857749
Hospital Revenue Code	390
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$469.78
Rate for Payer: Allwell Medicaid	$469.78
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$469.78
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$469.78
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$469.78
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$947.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Aph Plt ACDA LR Irr 1

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857749
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr 2

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857750
Hospital Revenue Code	390
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$469.78
Rate for Payer: Allwell Medicaid	$469.78
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$469.78
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$469.78
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$469.78
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$947.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Aph Plt ACDA LR Irr 2

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857750
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr 3

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857751
Hospital Revenue Code	390
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$469.78
Rate for Payer: Allwell Medicaid	$469.78
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$469.78
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$469.78
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$469.78
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$947.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Aph Plt ACDA LR Irr 3

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	857751
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr <3 X log 11 1

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	22316432
Hospital Revenue Code	390
Min. Negotiated Rate	$422.50
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Self Pay Self Pay	$1,300.00

Aph Plt ACDA LR Irr <3 X log 11 1

Facility

$1,625.00

Service Code	CPT P9034
Hospital Charge Code	22316432
Hospital Revenue Code	390
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$1,462.50
Rate for Payer: Aetna of AZ Commercial	$1,462.50
Rate for Payer: Aetna of AZ Medicare	$455.00
Rate for Payer: AHCCCS Medicaid	$469.78
Rate for Payer: Allwell Medicaid	$469.78
Rate for Payer: Allwell Medicare	$243.75
Rate for Payer: Amerigroup Medicare	$243.75
Rate for Payer: APIPA Medicare/Medicaid	$606.94
Rate for Payer: AZCH Complete Medicaid	$469.78
Rate for Payer: AZCH Complete Medicare	$243.75
Rate for Payer: Banner UC Health Medicaid	$469.78
Rate for Payer: Banner UC Health Medicare	$243.75
Rate for Payer: Bisbee Police All Plans	$422.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,105.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cigna of AZ Commercial	$1,056.25
Rate for Payer: Copperpoint Commercial	$402.19
Rate for Payer: Health Net of AZ Commercial	$975.00
Rate for Payer: Health Net of AZ Medicare	$455.00
Rate for Payer: Humana of AZ Medicare	$243.75
Rate for Payer: Mercy Care Medicaid	$469.78
Rate for Payer: Self Pay Self Pay	$1,300.00
Rate for Payer: TriWest Medicare	$243.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$947.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$292.50

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$119.85
Rate for Payer: Amerigroup Medicare	$119.85
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$119.85
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$119.85
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$119.85
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$119.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC ACDA AS1 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011918
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$119.85
Rate for Payer: Amerigroup Medicare	$119.85
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$119.85
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$119.85
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$119.85
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$119.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC ACDA AS1 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	3566198
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC ACDA AS1 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	3566199
Hospital Revenue Code	390
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Aetna of AZ Medicare	$213.08
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$114.15
Rate for Payer: Amerigroup Medicare	$114.15
Rate for Payer: APIPA Medicare/Medicaid	$284.23
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$114.15
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$114.15
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$517.48
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$494.65
Rate for Payer: Copperpoint Commercial	$188.35
Rate for Payer: Health Net of AZ Commercial	$456.60
Rate for Payer: Health Net of AZ Medicare	$213.08
Rate for Payer: Humana of AZ Medicare	$114.15
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$608.80
Rate for Payer: TriWest Medicare	$114.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$443.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.98

Aph RBC ACDA AS1 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	3566199
Hospital Revenue Code	390
Min. Negotiated Rate	$197.86
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Cash Price	$608.80
Rate for Payer: Self Pay Self Pay	$608.80

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC ACDA AS1 LR Irr

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	8545368
Hospital Revenue Code	390
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$119.85
Rate for Payer: Amerigroup Medicare	$119.85
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$119.85
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$119.85
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$119.85
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$119.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC CP2D AS3 LR

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	1011914
Hospital Revenue Code	390
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$119.85
Rate for Payer: Amerigroup Medicare	$119.85
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$119.85
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$119.85
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$119.85
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$119.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Aetna of AZ Medicare	$223.72
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$119.85
Rate for Payer: Amerigroup Medicare	$119.85
Rate for Payer: APIPA Medicare/Medicaid	$298.43
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$119.85
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$119.85
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$543.32
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cash Price	$639.20
Rate for Payer: Cigna of AZ Commercial	$519.35
Rate for Payer: Copperpoint Commercial	$197.75
Rate for Payer: Health Net of AZ Commercial	$479.40
Rate for Payer: Health Net of AZ Medicare	$223.72
Rate for Payer: Humana of AZ Medicare	$119.85
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$639.20
Rate for Payer: TriWest Medicare	$119.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$465.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.82

Aph RBC CP2D AS3 LR 1

Facility

$799.00

Service Code	CPT P9016
Hospital Charge Code	4004202
Hospital Revenue Code	390
Min. Negotiated Rate	$207.74
Max. Negotiated Rate	$719.10
Rate for Payer: Aetna of AZ Commercial	$719.10
Rate for Payer: Bisbee Police All Plans	$207.74
Rate for Payer: Cash Price	$639.20
Rate for Payer: Self Pay Self Pay	$639.20

Aph RBC CP2D AS3 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	4004201
Hospital Revenue Code	390
Min. Negotiated Rate	$197.86
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Cash Price	$608.80
Rate for Payer: Self Pay Self Pay	$608.80

Aph RBC CP2D AS3 LR 2

Facility

$761.00

Service Code	CPT P9016
Hospital Charge Code	4004201
Hospital Revenue Code	390
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$684.90
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Aetna of AZ Medicare	$213.08
Rate for Payer: AHCCCS Medicaid	$273.34
Rate for Payer: Allwell Medicaid	$273.34
Rate for Payer: Allwell Medicare	$114.15
Rate for Payer: Amerigroup Medicare	$114.15
Rate for Payer: APIPA Medicare/Medicaid	$284.23
Rate for Payer: AZCH Complete Medicaid	$273.34
Rate for Payer: AZCH Complete Medicare	$114.15
Rate for Payer: Banner UC Health Medicaid	$273.34
Rate for Payer: Banner UC Health Medicare	$114.15
Rate for Payer: Bisbee Police All Plans	$197.86
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$517.48
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cash Price	$608.80
Rate for Payer: Cigna of AZ Commercial	$494.65
Rate for Payer: Copperpoint Commercial	$188.35
Rate for Payer: Health Net of AZ Commercial	$456.60
Rate for Payer: Health Net of AZ Medicare	$213.08
Rate for Payer: Humana of AZ Medicare	$114.15
Rate for Payer: Mercy Care Medicaid	$273.34
Rate for Payer: Self Pay Self Pay	$608.80
Rate for Payer: TriWest Medicare	$114.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$443.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.98

Know your out-of-pocket cost for care.

All Charges