Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

AQUASONIC GEL 01-08

Facility

$10.00

Hospital Charge Code	23566283
Hospital Revenue Code	270
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of AZ Commercial	$9.00
Rate for Payer: Aetna of AZ Medicare	$2.80
Rate for Payer: Allwell Medicare	$1.50
Rate for Payer: Amerigroup Medicare	$1.50
Rate for Payer: APIPA Medicare/Medicaid	$3.74
Rate for Payer: AZCH Complete Medicare	$1.50
Rate for Payer: Banner UC Health Medicare	$1.50
Rate for Payer: Bisbee Police All Plans	$2.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$6.80
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cigna of AZ Commercial	$7.00
Rate for Payer: Copperpoint Commercial	$2.48
Rate for Payer: Health Net of AZ Commercial	$6.00
Rate for Payer: Health Net of AZ Medicare	$2.80
Rate for Payer: Humana of AZ Medicare	$1.50
Rate for Payer: Self Pay Self Pay	$8.00
Rate for Payer: TriWest Medicare	$1.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$5.83
Rate for Payer: UnitedHealth Group of AZ Medicare	$1.80

AQUASONIC GEL 01-08

Facility

$10.00

Hospital Charge Code	23566283
Hospital Revenue Code	270
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of AZ Commercial	$9.00
Rate for Payer: Bisbee Police All Plans	$2.60
Rate for Payer: Cash Price	$8.00
Rate for Payer: Self Pay Self Pay	$8.00

ARMBOARD INFANT NEONATAL

Facility

$42.00

Hospital Charge Code	22543301
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Cash Price	$33.60
Rate for Payer: Self Pay Self Pay	$33.60

ARMBOARD INFANT NEONATAL

Facility

$42.00

Hospital Charge Code	22543301
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna of AZ Commercial	$37.80
Rate for Payer: Aetna of AZ Medicare	$11.76
Rate for Payer: Allwell Medicare	$6.30
Rate for Payer: Amerigroup Medicare	$6.30
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.30
Rate for Payer: Banner UC Health Medicare	$6.30
Rate for Payer: Bisbee Police All Plans	$10.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$28.56
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna of AZ Commercial	$29.40
Rate for Payer: Copperpoint Commercial	$10.40
Rate for Payer: Health Net of AZ Commercial	$25.20
Rate for Payer: Health Net of AZ Medicare	$11.76
Rate for Payer: Humana of AZ Medicare	$6.30
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

ARSENIC BLOOD

Facility

$314.00

Service Code	CPT 82175
Hospital Charge Code	22481463
Hospital Revenue Code	301
Min. Negotiated Rate	$81.64
Max. Negotiated Rate	$282.60
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Bisbee Police All Plans	$81.64
Rate for Payer: Cash Price	$251.20
Rate for Payer: Self Pay Self Pay	$251.20

ARSENIC BLOOD

Facility

$314.00

Service Code	CPT 82175
Hospital Charge Code	22481463
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$282.60
Rate for Payer: Aetna of AZ Commercial	$282.60
Rate for Payer: Aetna of AZ Medicare	$87.92
Rate for Payer: AHCCCS Medicaid	$18.97
Rate for Payer: Allwell Medicaid	$18.97
Rate for Payer: Allwell Medicare	$47.10
Rate for Payer: Amerigroup Medicare	$47.10
Rate for Payer: APIPA Medicare/Medicaid	$117.28
Rate for Payer: AZCH Complete Medicaid	$18.97
Rate for Payer: AZCH Complete Medicare	$47.10
Rate for Payer: Banner UC Health Medicaid	$18.97
Rate for Payer: Banner UC Health Medicare	$47.10
Rate for Payer: Bisbee Police All Plans	$81.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$213.52
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cigna of AZ Commercial	$204.10
Rate for Payer: Copperpoint Commercial	$77.72
Rate for Payer: Health Net of AZ Commercial	$188.40
Rate for Payer: Health Net of AZ Medicare	$87.92
Rate for Payer: Humana of AZ Medicare	$47.10
Rate for Payer: Mercy Care Medicaid	$18.97
Rate for Payer: Self Pay Self Pay	$251.20
Rate for Payer: TriWest Medicare	$47.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$183.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$56.52

Arsenic, Blood LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	1285590
Hospital Revenue Code	301
Min. Negotiated Rate	$77.74
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Cash Price	$239.20
Rate for Payer: Self Pay Self Pay	$239.20

Arsenic, Blood LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	1285590
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Aetna of AZ Medicare	$83.72
Rate for Payer: AHCCCS Medicaid	$18.97
Rate for Payer: Allwell Medicaid	$18.97
Rate for Payer: Allwell Medicare	$44.85
Rate for Payer: Amerigroup Medicare	$44.85
Rate for Payer: APIPA Medicare/Medicaid	$111.68
Rate for Payer: AZCH Complete Medicaid	$18.97
Rate for Payer: AZCH Complete Medicare	$44.85
Rate for Payer: Banner UC Health Medicaid	$18.97
Rate for Payer: Banner UC Health Medicare	$44.85
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$203.32
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cigna of AZ Commercial	$194.35
Rate for Payer: Copperpoint Commercial	$74.00
Rate for Payer: Health Net of AZ Commercial	$179.40
Rate for Payer: Health Net of AZ Medicare	$83.72
Rate for Payer: Humana of AZ Medicare	$44.85
Rate for Payer: Mercy Care Medicaid	$18.97
Rate for Payer: Self Pay Self Pay	$239.20
Rate for Payer: TriWest Medicare	$44.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.82

.Arsenic, Comment LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	22311133
Hospital Revenue Code	301
Min. Negotiated Rate	$77.74
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Cash Price	$239.20
Rate for Payer: Self Pay Self Pay	$239.20

.Arsenic, Comment LC

Facility

$299.00

Service Code	CPT 82175
Hospital Charge Code	22311133
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$269.10
Rate for Payer: Aetna of AZ Commercial	$269.10
Rate for Payer: Aetna of AZ Medicare	$83.72
Rate for Payer: AHCCCS Medicaid	$18.97
Rate for Payer: Allwell Medicaid	$18.97
Rate for Payer: Allwell Medicare	$44.85
Rate for Payer: Amerigroup Medicare	$44.85
Rate for Payer: APIPA Medicare/Medicaid	$111.68
Rate for Payer: AZCH Complete Medicaid	$18.97
Rate for Payer: AZCH Complete Medicare	$44.85
Rate for Payer: Banner UC Health Medicaid	$18.97
Rate for Payer: Banner UC Health Medicare	$44.85
Rate for Payer: Bisbee Police All Plans	$77.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$203.32
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cigna of AZ Commercial	$194.35
Rate for Payer: Copperpoint Commercial	$74.00
Rate for Payer: Health Net of AZ Commercial	$179.40
Rate for Payer: Health Net of AZ Medicare	$83.72
Rate for Payer: Humana of AZ Medicare	$44.85
Rate for Payer: Mercy Care Medicaid	$18.97
Rate for Payer: Self Pay Self Pay	$239.20
Rate for Payer: TriWest Medicare	$44.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$174.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.82

Arterial Blood Gas

Facility

$322.00

Service Code	CPT 82803
Hospital Charge Code	22521717
Hospital Revenue Code	301
Min. Negotiated Rate	$83.72
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna of AZ Commercial	$289.80
Rate for Payer: Bisbee Police All Plans	$83.72
Rate for Payer: Cash Price	$257.60
Rate for Payer: Self Pay Self Pay	$257.60

Arterial Blood Gas

Facility

$322.00

Service Code	CPT 82803
Hospital Charge Code	22521717
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna of AZ Commercial	$289.80
Rate for Payer: Aetna of AZ Medicare	$90.16
Rate for Payer: AHCCCS Medicaid	$26.07
Rate for Payer: Allwell Medicaid	$26.07
Rate for Payer: Allwell Medicare	$48.30
Rate for Payer: Amerigroup Medicare	$48.30
Rate for Payer: APIPA Medicare/Medicaid	$120.27
Rate for Payer: AZCH Complete Medicaid	$26.07
Rate for Payer: AZCH Complete Medicare	$48.30
Rate for Payer: Banner UC Health Medicaid	$26.07
Rate for Payer: Banner UC Health Medicare	$48.30
Rate for Payer: Bisbee Police All Plans	$83.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$218.96
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cigna of AZ Commercial	$209.30
Rate for Payer: Copperpoint Commercial	$79.70
Rate for Payer: Health Net of AZ Commercial	$193.20
Rate for Payer: Health Net of AZ Medicare	$90.16
Rate for Payer: Humana of AZ Medicare	$48.30
Rate for Payer: Mercy Care Medicaid	$26.07
Rate for Payer: Self Pay Self Pay	$257.60
Rate for Payer: TriWest Medicare	$48.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$187.73
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.96

Arterial Blood Gas Standard

Facility

$324.00

Service Code	CPT 82803
Hospital Charge Code	22146116
Hospital Revenue Code	301
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of AZ Commercial	$291.60
Rate for Payer: Bisbee Police All Plans	$84.24
Rate for Payer: Cash Price	$259.20
Rate for Payer: Self Pay Self Pay	$259.20

Arterial Blood Gas Standard

Facility

$324.00

Service Code	CPT 82803
Hospital Charge Code	22146116
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$291.60
Rate for Payer: Aetna of AZ Commercial	$291.60
Rate for Payer: Aetna of AZ Medicare	$90.72
Rate for Payer: AHCCCS Medicaid	$26.07
Rate for Payer: Allwell Medicaid	$26.07
Rate for Payer: Allwell Medicare	$48.60
Rate for Payer: Amerigroup Medicare	$48.60
Rate for Payer: APIPA Medicare/Medicaid	$121.01
Rate for Payer: AZCH Complete Medicaid	$26.07
Rate for Payer: AZCH Complete Medicare	$48.60
Rate for Payer: Banner UC Health Medicaid	$26.07
Rate for Payer: Banner UC Health Medicare	$48.60
Rate for Payer: Bisbee Police All Plans	$84.24
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$220.32
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cigna of AZ Commercial	$210.60
Rate for Payer: Copperpoint Commercial	$80.19
Rate for Payer: Health Net of AZ Commercial	$194.40
Rate for Payer: Health Net of AZ Medicare	$90.72
Rate for Payer: Humana of AZ Medicare	$48.60
Rate for Payer: Mercy Care Medicaid	$26.07
Rate for Payer: Self Pay Self Pay	$259.20
Rate for Payer: TriWest Medicare	$48.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$188.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$58.32

ARTHRODESIS GREAT TOE; INTERPHALANGEAL JOINT

Facility

$1,622.00

Service Code	CPT 28755
Hospital Charge Code	24043300
Hospital Revenue Code	360
Min. Negotiated Rate	$243.30
Max. Negotiated Rate	$9,084.18
Rate for Payer: Aetna of AZ Commercial	$1,459.80
Rate for Payer: Aetna of AZ Medicare	$454.16
Rate for Payer: AHCCCS Medicaid	$9,084.18
Rate for Payer: Allwell Medicaid	$9,084.18
Rate for Payer: Allwell Medicare	$243.30
Rate for Payer: Amerigroup Medicare	$243.30
Rate for Payer: APIPA Medicare/Medicaid	$605.82
Rate for Payer: AZCH Complete Medicaid	$9,084.18
Rate for Payer: AZCH Complete Medicare	$243.30
Rate for Payer: Banner UC Health Medicaid	$9,084.18
Rate for Payer: Banner UC Health Medicare	$243.30
Rate for Payer: Bisbee Police All Plans	$421.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,102.96
Rate for Payer: Cash Price	$1,297.60
Rate for Payer: Cash Price	$1,297.60
Rate for Payer: Cigna of AZ Commercial	$811.00
Rate for Payer: Copperpoint Commercial	$401.44
Rate for Payer: Health Net of AZ Commercial	$973.20
Rate for Payer: Health Net of AZ Medicare	$454.16
Rate for Payer: Humana of AZ Medicare	$243.30
Rate for Payer: Mercy Care Medicaid	$9,084.18
Rate for Payer: Self Pay Self Pay	$1,297.60
Rate for Payer: TriWest Medicare	$243.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$291.96

ARTHRODESIS GREAT TOE; INTERPHALANGEAL JOINT

Facility

$1,622.00

Service Code	CPT 28755
Hospital Charge Code	24043300
Hospital Revenue Code	360
Min. Negotiated Rate	$421.72
Max. Negotiated Rate	$1,459.80
Rate for Payer: Aetna of AZ Commercial	$1,459.80
Rate for Payer: Bisbee Police All Plans	$421.72
Rate for Payer: Cash Price	$1,297.60
Rate for Payer: Self Pay Self Pay	$1,297.60

ARTHRODESIS GREAT TOE; METATARSOPHALANGEAL JOINT

Facility

$2,846.00

Service Code	CPT 28750
Hospital Charge Code	24043318
Hospital Revenue Code	360
Min. Negotiated Rate	$739.96
Max. Negotiated Rate	$2,561.40
Rate for Payer: Aetna of AZ Commercial	$2,561.40
Rate for Payer: Bisbee Police All Plans	$739.96
Rate for Payer: Cash Price	$2,276.80
Rate for Payer: Self Pay Self Pay	$2,276.80

ARTHRODESIS GREAT TOE; METATARSOPHALANGEAL JOINT

Facility

$2,846.00

Service Code	CPT 28750
Hospital Charge Code	24043318
Hospital Revenue Code	360
Min. Negotiated Rate	$426.90
Max. Negotiated Rate	$9,084.18
Rate for Payer: Aetna of AZ Commercial	$2,561.40
Rate for Payer: Aetna of AZ Medicare	$796.88
Rate for Payer: AHCCCS Medicaid	$9,084.18
Rate for Payer: Allwell Medicaid	$9,084.18
Rate for Payer: Allwell Medicare	$426.90
Rate for Payer: Amerigroup Medicare	$426.90
Rate for Payer: APIPA Medicare/Medicaid	$1,062.98
Rate for Payer: AZCH Complete Medicaid	$9,084.18
Rate for Payer: AZCH Complete Medicare	$426.90
Rate for Payer: Banner UC Health Medicaid	$9,084.18
Rate for Payer: Banner UC Health Medicare	$426.90
Rate for Payer: Bisbee Police All Plans	$739.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,935.28
Rate for Payer: Cash Price	$2,276.80
Rate for Payer: Cash Price	$2,276.80
Rate for Payer: Cigna of AZ Commercial	$1,423.00
Rate for Payer: Copperpoint Commercial	$704.38
Rate for Payer: Health Net of AZ Commercial	$1,707.60
Rate for Payer: Health Net of AZ Medicare	$796.88
Rate for Payer: Humana of AZ Medicare	$426.90
Rate for Payer: Mercy Care Medicaid	$9,084.18
Rate for Payer: Self Pay Self Pay	$2,276.80
Rate for Payer: TriWest Medicare	$426.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$512.28

ARTHRODESIS MIDTARSAL OR TARSOMETATARSAL MULTIPLE OR TRANSVERSE

Facility

$3,571.00

Service Code	CPT 28730
Hospital Charge Code	24043324
Hospital Revenue Code	360
Min. Negotiated Rate	$928.46
Max. Negotiated Rate	$3,213.90
Rate for Payer: Aetna of AZ Commercial	$3,213.90
Rate for Payer: Bisbee Police All Plans	$928.46
Rate for Payer: Cash Price	$2,856.80
Rate for Payer: Self Pay Self Pay	$2,856.80

ARTHRODESIS MIDTARSAL OR TARSOMETATARSAL MULTIPLE OR TRANSVERSE

Facility

$3,571.00

Service Code	CPT 28730
Hospital Charge Code	24043324
Hospital Revenue Code	360
Min. Negotiated Rate	$535.65
Max. Negotiated Rate	$17,856.40
Rate for Payer: Aetna of AZ Commercial	$3,213.90
Rate for Payer: Aetna of AZ Medicare	$999.88
Rate for Payer: AHCCCS Medicaid	$17,856.40
Rate for Payer: Allwell Medicaid	$17,856.40
Rate for Payer: Allwell Medicare	$535.65
Rate for Payer: Amerigroup Medicare	$535.65
Rate for Payer: APIPA Medicare/Medicaid	$1,333.77
Rate for Payer: AZCH Complete Medicaid	$17,856.40
Rate for Payer: AZCH Complete Medicare	$535.65
Rate for Payer: Banner UC Health Medicaid	$17,856.40
Rate for Payer: Banner UC Health Medicare	$535.65
Rate for Payer: Bisbee Police All Plans	$928.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,428.28
Rate for Payer: Cash Price	$2,856.80
Rate for Payer: Cash Price	$2,856.80
Rate for Payer: Cigna of AZ Commercial	$1,785.50
Rate for Payer: Copperpoint Commercial	$883.82
Rate for Payer: Health Net of AZ Commercial	$2,142.60
Rate for Payer: Health Net of AZ Medicare	$999.88
Rate for Payer: Humana of AZ Medicare	$535.65
Rate for Payer: Mercy Care Medicaid	$17,856.40
Rate for Payer: Self Pay Self Pay	$2,856.80
Rate for Payer: TriWest Medicare	$535.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$5,265.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$642.78

ARTHROSCOPIC PACK

Facility

$242.00

Hospital Charge Code	22354803
Hospital Revenue Code	270
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Aetna of AZ Medicare	$67.76
Rate for Payer: Allwell Medicare	$36.30
Rate for Payer: Amerigroup Medicare	$36.30
Rate for Payer: APIPA Medicare/Medicaid	$90.39
Rate for Payer: AZCH Complete Medicare	$36.30
Rate for Payer: Banner UC Health Medicare	$36.30
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$164.56
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$169.40
Rate for Payer: Copperpoint Commercial	$59.90
Rate for Payer: Health Net of AZ Commercial	$145.20
Rate for Payer: Health Net of AZ Medicare	$67.76
Rate for Payer: Humana of AZ Medicare	$36.30
Rate for Payer: Self Pay Self Pay	$193.60
Rate for Payer: TriWest Medicare	$36.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$141.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.56

ARTHROSCOPIC PACK

Facility

$242.00

Hospital Charge Code	22354803
Hospital Revenue Code	270
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$217.80
Rate for Payer: Aetna of AZ Commercial	$217.80
Rate for Payer: Bisbee Police All Plans	$62.92
Rate for Payer: Cash Price	$193.60
Rate for Payer: Self Pay Self Pay	$193.60

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND L

Facility

$3,056.00

Service Code	CPT 29880
Hospital Charge Code	27357092
Hospital Revenue Code	362
Min. Negotiated Rate	$794.56
Max. Negotiated Rate	$2,750.40
Rate for Payer: Aetna of AZ Commercial	$2,750.40
Rate for Payer: Bisbee Police All Plans	$794.56
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Self Pay Self Pay	$2,444.80

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND L

Facility

$3,056.00

Service Code	CPT 29880
Hospital Charge Code	27357092
Hospital Revenue Code	362
Min. Negotiated Rate	$458.40
Max. Negotiated Rate	$4,104.08
Rate for Payer: Aetna of AZ Commercial	$2,750.40
Rate for Payer: Aetna of AZ Medicare	$855.68
Rate for Payer: AHCCCS Medicaid	$4,104.08
Rate for Payer: Allwell Medicaid	$4,104.08
Rate for Payer: Allwell Medicare	$458.40
Rate for Payer: Amerigroup Medicare	$458.40
Rate for Payer: APIPA Medicare/Medicaid	$1,141.42
Rate for Payer: AZCH Complete Medicaid	$4,104.08
Rate for Payer: AZCH Complete Medicare	$458.40
Rate for Payer: Banner UC Health Medicaid	$4,104.08
Rate for Payer: Banner UC Health Medicare	$458.40
Rate for Payer: Bisbee Police All Plans	$794.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,078.08
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Cigna of AZ Commercial	$1,986.40
Rate for Payer: Copperpoint Commercial	$756.36
Rate for Payer: Health Net of AZ Commercial	$1,833.60
Rate for Payer: Health Net of AZ Medicare	$855.68
Rate for Payer: Humana of AZ Medicare	$458.40
Rate for Payer: Mercy Care Medicaid	$4,104.08
Rate for Payer: Self Pay Self Pay	$2,444.80
Rate for Payer: TriWest Medicare	$458.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$550.08

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LA

Facility

$2,945.00

Service Code	CPT 29881
Hospital Charge Code	27357091
Hospital Revenue Code	360
Min. Negotiated Rate	$765.70
Max. Negotiated Rate	$2,650.50
Rate for Payer: Aetna of AZ Commercial	$2,650.50
Rate for Payer: Bisbee Police All Plans	$765.70
Rate for Payer: Cash Price	$2,356.00
Rate for Payer: Self Pay Self Pay	$2,356.00

Know your out-of-pocket cost for care.

All Charges