Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

01999 ANES UNLISTED ANESTHESIA PROCEDURE BASE CHG AND 1ST MI

Facility

$490.00

Service Code	CPT 01999
Hospital Charge Code	22406193
Hospital Revenue Code	964
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Aetna of AZ Medicare	$137.20
Rate for Payer: Allwell Medicare	$78.40
Rate for Payer: Amerigroup Medicare	$78.40
Rate for Payer: APIPA Medicare/Medicaid	$183.01
Rate for Payer: AZCH Complete Medicare	$78.40
Rate for Payer: Banner UC Health Medicare	$78.40
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$333.20
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cigna of AZ Commercial	$343.00
Rate for Payer: Copperpoint Commercial	$121.28
Rate for Payer: Health Net of AZ Commercial	$294.00
Rate for Payer: Health Net of AZ Medicare	$137.20
Rate for Payer: Humana of AZ Medicare	$78.40
Rate for Payer: Self Pay Self Pay	$392.00
Rate for Payer: TriWest Medicare	$78.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$285.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$88.20

01999 ANES UNLISTED ANESTHESIA PROCEDURE BASE CHG AND 1ST MI

Facility

$490.00

Service Code	CPT 01999
Hospital Charge Code	22406193
Hospital Revenue Code	964
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna of AZ Commercial	$441.00
Rate for Payer: Bisbee Police All Plans	$127.40
Rate for Payer: Cash Price	$392.00
Rate for Payer: Self Pay Self Pay	$392.00

0 Ethibond Excel CT-0

Facility

$85.00

Hospital Charge Code	22926434
Hospital Revenue Code	272
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Cash Price	$68.00
Rate for Payer: Self Pay Self Pay	$68.00

0 Ethibond Excel CT-0

Facility

$85.00

Hospital Charge Code	22926434
Hospital Revenue Code	272
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna of AZ Commercial	$76.50
Rate for Payer: Aetna of AZ Medicare	$23.80
Rate for Payer: Allwell Medicare	$13.60
Rate for Payer: Amerigroup Medicare	$13.60
Rate for Payer: APIPA Medicare/Medicaid	$31.75
Rate for Payer: AZCH Complete Medicare	$13.60
Rate for Payer: Banner UC Health Medicare	$13.60
Rate for Payer: Bisbee Police All Plans	$22.10
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.80
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cigna of AZ Commercial	$59.50
Rate for Payer: Copperpoint Commercial	$21.04
Rate for Payer: Health Net of AZ Commercial	$51.00
Rate for Payer: Health Net of AZ Medicare	$23.80
Rate for Payer: Humana of AZ Medicare	$13.60
Rate for Payer: Self Pay Self Pay	$68.00
Rate for Payer: TriWest Medicare	$13.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$49.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.30

0 Ethibond Excel OS-4

Facility

$18.00

Hospital Charge Code	22926436
Hospital Revenue Code	272
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Aetna of AZ Medicare	$5.04
Rate for Payer: Allwell Medicare	$2.88
Rate for Payer: Amerigroup Medicare	$2.88
Rate for Payer: APIPA Medicare/Medicaid	$6.72
Rate for Payer: AZCH Complete Medicare	$2.88
Rate for Payer: Banner UC Health Medicare	$2.88
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$12.24
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of AZ Commercial	$12.60
Rate for Payer: Copperpoint Commercial	$4.46
Rate for Payer: Health Net of AZ Commercial	$10.80
Rate for Payer: Health Net of AZ Medicare	$5.04
Rate for Payer: Humana of AZ Medicare	$2.88
Rate for Payer: Self Pay Self Pay	$14.40
Rate for Payer: TriWest Medicare	$2.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$10.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$3.24

0 Ethibond Excel OS-4

Facility

$18.00

Hospital Charge Code	22926436
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna of AZ Commercial	$16.20
Rate for Payer: Bisbee Police All Plans	$4.68
Rate for Payer: Cash Price	$14.40
Rate for Payer: Self Pay Self Pay	$14.40

0 Surgigut GS-23

Facility

$36.00

Hospital Charge Code	22926443
Hospital Revenue Code	272
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Aetna of AZ Medicare	$10.08
Rate for Payer: Allwell Medicare	$5.76
Rate for Payer: Amerigroup Medicare	$5.76
Rate for Payer: APIPA Medicare/Medicaid	$13.45
Rate for Payer: AZCH Complete Medicare	$5.76
Rate for Payer: Banner UC Health Medicare	$5.76
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$24.48
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna of AZ Commercial	$25.20
Rate for Payer: Copperpoint Commercial	$8.91
Rate for Payer: Health Net of AZ Commercial	$21.60
Rate for Payer: Health Net of AZ Medicare	$10.08
Rate for Payer: Humana of AZ Medicare	$5.76
Rate for Payer: Self Pay Self Pay	$28.80
Rate for Payer: TriWest Medicare	$5.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$20.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$6.48

0 Surgigut GS-23

Facility

$36.00

Hospital Charge Code	22926443
Hospital Revenue Code	272
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna of AZ Commercial	$32.40
Rate for Payer: Bisbee Police All Plans	$9.36
Rate for Payer: Cash Price	$28.80
Rate for Payer: Self Pay Self Pay	$28.80

10060 I D ABSCESS

Facility

$583.00

Service Code	CPT 10060
Hospital Charge Code	22273442
Hospital Revenue Code	450
Min. Negotiated Rate	$151.58
Max. Negotiated Rate	$524.70
Rate for Payer: Aetna of AZ Commercial	$524.70
Rate for Payer: Bisbee Police All Plans	$151.58
Rate for Payer: Cash Price	$466.40
Rate for Payer: Self Pay Self Pay	$466.40

10060 I D ABSCESS

Facility

$583.00

Service Code	CPT 10060
Hospital Charge Code	22273442
Hospital Revenue Code	450
Min. Negotiated Rate	$93.28
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$524.70
Rate for Payer: Aetna of AZ Medicare	$163.24
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$93.28
Rate for Payer: Amerigroup Medicare	$93.28
Rate for Payer: APIPA Medicare/Medicaid	$217.75
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$93.28
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$93.28
Rate for Payer: Bisbee Police All Plans	$151.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$396.44
Rate for Payer: Cash Price	$466.40
Rate for Payer: Cash Price	$466.40
Rate for Payer: Cigna of AZ Commercial	$408.10
Rate for Payer: Copperpoint Commercial	$144.29
Rate for Payer: Health Net of AZ Commercial	$349.80
Rate for Payer: Health Net of AZ Medicare	$163.24
Rate for Payer: Humana of AZ Medicare	$93.28
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$466.40
Rate for Payer: TriWest Medicare	$93.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.94

10120 INCS REM FOB SUB CUT S

Facility

$582.00

Service Code	CPT 10120
Hospital Charge Code	22282760
Hospital Revenue Code	450
Min. Negotiated Rate	$151.32
Max. Negotiated Rate	$523.80
Rate for Payer: Aetna of AZ Commercial	$523.80
Rate for Payer: Bisbee Police All Plans	$151.32
Rate for Payer: Cash Price	$465.60
Rate for Payer: Self Pay Self Pay	$465.60

10120 INCS REM FOB SUB CUT S

Facility

$582.00

Service Code	CPT 10120
Hospital Charge Code	22282760
Hospital Revenue Code	450
Min. Negotiated Rate	$93.12
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$523.80
Rate for Payer: Aetna of AZ Medicare	$162.96
Rate for Payer: AHCCCS Medicaid	$250.73
Rate for Payer: Allwell Medicaid	$250.73
Rate for Payer: Allwell Medicare	$93.12
Rate for Payer: Amerigroup Medicare	$93.12
Rate for Payer: APIPA Medicare/Medicaid	$217.38
Rate for Payer: AZCH Complete Medicaid	$250.73
Rate for Payer: AZCH Complete Medicare	$93.12
Rate for Payer: Banner UC Health Medicaid	$250.73
Rate for Payer: Banner UC Health Medicare	$93.12
Rate for Payer: Bisbee Police All Plans	$151.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$395.76
Rate for Payer: Cash Price	$465.60
Rate for Payer: Cash Price	$465.60
Rate for Payer: Cigna of AZ Commercial	$407.40
Rate for Payer: Copperpoint Commercial	$144.04
Rate for Payer: Health Net of AZ Commercial	$349.20
Rate for Payer: Health Net of AZ Medicare	$162.96
Rate for Payer: Humana of AZ Medicare	$93.12
Rate for Payer: Mercy Care Medicaid	$250.73
Rate for Payer: Self Pay Self Pay	$465.60
Rate for Payer: TriWest Medicare	$93.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$104.76

10140 ID HMTMA SRMA TLD COLEC

Facility

$431.00

Service Code	CPT 10140
Hospital Charge Code	22282761
Hospital Revenue Code	450
Min. Negotiated Rate	$68.96
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$387.90
Rate for Payer: Aetna of AZ Medicare	$120.68
Rate for Payer: AHCCCS Medicaid	$1,020.08
Rate for Payer: Allwell Medicaid	$1,020.08
Rate for Payer: Allwell Medicare	$68.96
Rate for Payer: Amerigroup Medicare	$68.96
Rate for Payer: APIPA Medicare/Medicaid	$160.98
Rate for Payer: AZCH Complete Medicaid	$1,020.08
Rate for Payer: AZCH Complete Medicare	$68.96
Rate for Payer: Banner UC Health Medicaid	$1,020.08
Rate for Payer: Banner UC Health Medicare	$68.96
Rate for Payer: Bisbee Police All Plans	$112.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$293.08
Rate for Payer: Cash Price	$344.80
Rate for Payer: Cash Price	$344.80
Rate for Payer: Cigna of AZ Commercial	$301.70
Rate for Payer: Copperpoint Commercial	$106.67
Rate for Payer: Health Net of AZ Commercial	$258.60
Rate for Payer: Health Net of AZ Medicare	$120.68
Rate for Payer: Humana of AZ Medicare	$68.96
Rate for Payer: Mercy Care Medicaid	$1,020.08
Rate for Payer: Self Pay Self Pay	$344.80
Rate for Payer: TriWest Medicare	$68.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$77.58

10140 ID HMTMA SRMA TLD COLEC

Facility

$431.00

Service Code	CPT 10140
Hospital Charge Code	22282761
Hospital Revenue Code	450
Min. Negotiated Rate	$112.06
Max. Negotiated Rate	$387.90
Rate for Payer: Aetna of AZ Commercial	$387.90
Rate for Payer: Bisbee Police All Plans	$112.06
Rate for Payer: Cash Price	$344.80
Rate for Payer: Self Pay Self Pay	$344.80

10MM BLUNT TIP TROCAR

Facility

$796.00

Hospital Charge Code	22561229
Hospital Revenue Code	272
Min. Negotiated Rate	$127.36
Max. Negotiated Rate	$716.40
Rate for Payer: Aetna of AZ Commercial	$716.40
Rate for Payer: Aetna of AZ Medicare	$222.88
Rate for Payer: Allwell Medicare	$127.36
Rate for Payer: Amerigroup Medicare	$127.36
Rate for Payer: APIPA Medicare/Medicaid	$297.31
Rate for Payer: AZCH Complete Medicare	$127.36
Rate for Payer: Banner UC Health Medicare	$127.36
Rate for Payer: Bisbee Police All Plans	$206.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$541.28
Rate for Payer: Cash Price	$636.80
Rate for Payer: Cigna of AZ Commercial	$557.20
Rate for Payer: Copperpoint Commercial	$197.01
Rate for Payer: Health Net of AZ Commercial	$477.60
Rate for Payer: Health Net of AZ Medicare	$222.88
Rate for Payer: Humana of AZ Medicare	$127.36
Rate for Payer: Self Pay Self Pay	$636.80
Rate for Payer: TriWest Medicare	$127.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$464.07
Rate for Payer: UnitedHealth Group of AZ Medicare	$143.28

10MM BLUNT TIP TROCAR

Facility

$796.00

Hospital Charge Code	22561229
Hospital Revenue Code	272
Min. Negotiated Rate	$206.96
Max. Negotiated Rate	$716.40
Rate for Payer: Aetna of AZ Commercial	$716.40
Rate for Payer: Bisbee Police All Plans	$206.96
Rate for Payer: Cash Price	$636.80
Rate for Payer: Self Pay Self Pay	$636.80

11000 DBR INFC SKIN 10% BDY SU

Facility

$175.00

Service Code	CPT 11000
Hospital Charge Code	22282762
Hospital Revenue Code	450
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Aetna of AZ Medicare	$49.00
Rate for Payer: AHCCCS Medicaid	$380.02
Rate for Payer: Allwell Medicaid	$380.02
Rate for Payer: Allwell Medicare	$28.00
Rate for Payer: Amerigroup Medicare	$28.00
Rate for Payer: APIPA Medicare/Medicaid	$65.36
Rate for Payer: AZCH Complete Medicaid	$380.02
Rate for Payer: AZCH Complete Medicare	$28.00
Rate for Payer: Banner UC Health Medicaid	$380.02
Rate for Payer: Banner UC Health Medicare	$28.00
Rate for Payer: Bisbee Police All Plans	$45.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$119.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cigna of AZ Commercial	$122.50
Rate for Payer: Copperpoint Commercial	$43.31
Rate for Payer: Health Net of AZ Commercial	$105.00
Rate for Payer: Health Net of AZ Medicare	$49.00
Rate for Payer: Humana of AZ Medicare	$28.00
Rate for Payer: Mercy Care Medicaid	$380.02
Rate for Payer: Self Pay Self Pay	$140.00
Rate for Payer: TriWest Medicare	$28.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$31.50

11000 DBR INFC SKIN 10% BDY SU

Facility

$175.00

Service Code	CPT 11000
Hospital Charge Code	22282762
Hospital Revenue Code	450
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna of AZ Commercial	$157.50
Rate for Payer: Bisbee Police All Plans	$45.50
Rate for Payer: Cash Price	$140.00
Rate for Payer: Self Pay Self Pay	$140.00

11730 AVULS NAIL SIMPLE SGL

Facility

$338.00

Service Code	CPT 11730
Hospital Charge Code	22282763
Hospital Revenue Code	450
Min. Negotiated Rate	$54.08
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Aetna of AZ Medicare	$94.64
Rate for Payer: AHCCCS Medicaid	$130.17
Rate for Payer: Allwell Medicaid	$130.17
Rate for Payer: Allwell Medicare	$54.08
Rate for Payer: Amerigroup Medicare	$54.08
Rate for Payer: APIPA Medicare/Medicaid	$126.24
Rate for Payer: AZCH Complete Medicaid	$130.17
Rate for Payer: AZCH Complete Medicare	$54.08
Rate for Payer: Banner UC Health Medicaid	$130.17
Rate for Payer: Banner UC Health Medicare	$54.08
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$229.84
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cigna of AZ Commercial	$236.60
Rate for Payer: Copperpoint Commercial	$83.66
Rate for Payer: Health Net of AZ Commercial	$202.80
Rate for Payer: Health Net of AZ Medicare	$94.64
Rate for Payer: Humana of AZ Medicare	$54.08
Rate for Payer: Mercy Care Medicaid	$130.17
Rate for Payer: Self Pay Self Pay	$270.40
Rate for Payer: TriWest Medicare	$54.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$60.84

11730 AVULS NAIL SIMPLE SGL

Facility

$338.00

Service Code	CPT 11730
Hospital Charge Code	22282763
Hospital Revenue Code	450
Min. Negotiated Rate	$87.88
Max. Negotiated Rate	$304.20
Rate for Payer: Aetna of AZ Commercial	$304.20
Rate for Payer: Bisbee Police All Plans	$87.88
Rate for Payer: Cash Price	$270.40
Rate for Payer: Self Pay Self Pay	$270.40

11732 EA ADDTL NAIL PLATE AVUI

Facility

$164.00

Service Code	CPT 11732
Hospital Charge Code	22282764
Hospital Revenue Code	450
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Cash Price	$131.20
Rate for Payer: Self Pay Self Pay	$131.20

11732 EA ADDTL NAIL PLATE AVUI

Facility

$164.00

Service Code	CPT 11732
Hospital Charge Code	22282764
Hospital Revenue Code	450
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$147.60
Rate for Payer: Aetna of AZ Medicare	$45.92
Rate for Payer: AHCCCS Medicaid	$68.99
Rate for Payer: Allwell Medicaid	$68.99
Rate for Payer: Allwell Medicare	$26.24
Rate for Payer: Amerigroup Medicare	$26.24
Rate for Payer: APIPA Medicare/Medicaid	$61.25
Rate for Payer: AZCH Complete Medicaid	$68.99
Rate for Payer: AZCH Complete Medicare	$26.24
Rate for Payer: Banner UC Health Medicaid	$68.99
Rate for Payer: Banner UC Health Medicare	$26.24
Rate for Payer: Bisbee Police All Plans	$42.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$111.52
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cigna of AZ Commercial	$114.80
Rate for Payer: Copperpoint Commercial	$40.59
Rate for Payer: Health Net of AZ Commercial	$98.40
Rate for Payer: Health Net of AZ Medicare	$45.92
Rate for Payer: Humana of AZ Medicare	$26.24
Rate for Payer: Mercy Care Medicaid	$68.99
Rate for Payer: Self Pay Self Pay	$131.20
Rate for Payer: TriWest Medicare	$26.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$29.52

11740 EVAC SUB HEMATOMA

Facility

$170.00

Service Code	CPT 11740
Hospital Charge Code	22282765
Hospital Revenue Code	450
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Cash Price	$136.00
Rate for Payer: Self Pay Self Pay	$136.00

11740 EVAC SUB HEMATOMA

Facility

$170.00

Service Code	CPT 11740
Hospital Charge Code	22282765
Hospital Revenue Code	450
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$153.00
Rate for Payer: Aetna of AZ Medicare	$47.60
Rate for Payer: AHCCCS Medicaid	$81.16
Rate for Payer: Allwell Medicaid	$81.16
Rate for Payer: Allwell Medicare	$27.20
Rate for Payer: Amerigroup Medicare	$27.20
Rate for Payer: APIPA Medicare/Medicaid	$63.49
Rate for Payer: AZCH Complete Medicaid	$81.16
Rate for Payer: AZCH Complete Medicare	$27.20
Rate for Payer: Banner UC Health Medicaid	$81.16
Rate for Payer: Banner UC Health Medicare	$27.20
Rate for Payer: Bisbee Police All Plans	$44.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$115.60
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cigna of AZ Commercial	$119.00
Rate for Payer: Copperpoint Commercial	$42.08
Rate for Payer: Health Net of AZ Commercial	$102.00
Rate for Payer: Health Net of AZ Medicare	$47.60
Rate for Payer: Humana of AZ Medicare	$27.20
Rate for Payer: Mercy Care Medicaid	$81.16
Rate for Payer: Self Pay Self Pay	$136.00
Rate for Payer: TriWest Medicare	$27.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.60

11760 RPR NAIL BED

Facility

$671.00

Service Code	CPT 11760
Hospital Charge Code	22282766
Hospital Revenue Code	450
Min. Negotiated Rate	$174.46
Max. Negotiated Rate	$603.90
Rate for Payer: Aetna of AZ Commercial	$603.90
Rate for Payer: Bisbee Police All Plans	$174.46
Rate for Payer: Cash Price	$536.80
Rate for Payer: Self Pay Self Pay	$536.80

Know your out-of-pocket cost for care.

All Charges