Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Bill Irradiation

Facility

$44.00

Service Code	CPT 86945
Hospital Charge Code	4176274
Hospital Revenue Code	390
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Cash Price	$35.20
Rate for Payer: Self Pay Self Pay	$35.20

Bill Irradiation

Facility

$44.00

Service Code	CPT 86945
Hospital Charge Code	4176274
Hospital Revenue Code	390
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$39.60
Rate for Payer: Aetna of AZ Commercial	$39.60
Rate for Payer: Aetna of AZ Medicare	$12.32
Rate for Payer: Allwell Medicare	$7.04
Rate for Payer: Amerigroup Medicare	$7.04
Rate for Payer: APIPA Medicare/Medicaid	$16.43
Rate for Payer: AZCH Complete Medicare	$7.04
Rate for Payer: Banner UC Health Medicare	$7.04
Rate for Payer: Bisbee Police All Plans	$11.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$29.92
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cigna of AZ Commercial	$28.60
Rate for Payer: Copperpoint Commercial	$10.89
Rate for Payer: Health Net of AZ Commercial	$26.40
Rate for Payer: Health Net of AZ Medicare	$12.32
Rate for Payer: Humana of AZ Medicare	$7.04
Rate for Payer: Self Pay Self Pay	$35.20
Rate for Payer: TriWest Medicare	$7.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$25.65
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.92

Bill Observed Chain of Custody

Facility

$47.00

Service Code	CPT 81001
Hospital Charge Code	22511902
Hospital Revenue Code	300
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Cash Price	$37.60
Rate for Payer: Self Pay Self Pay	$37.60

Bill Observed Chain of Custody

Facility

$47.00

Service Code	CPT 81001
Hospital Charge Code	22511902
Hospital Revenue Code	300
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of AZ Commercial	$42.30
Rate for Payer: Aetna of AZ Medicare	$13.16
Rate for Payer: Allwell Medicare	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: APIPA Medicare/Medicaid	$17.55
Rate for Payer: AZCH Complete Medicare	$7.52
Rate for Payer: Banner UC Health Medicare	$7.52
Rate for Payer: Bisbee Police All Plans	$12.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$31.96
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cigna of AZ Commercial	$30.55
Rate for Payer: Copperpoint Commercial	$11.63
Rate for Payer: Health Net of AZ Commercial	$28.20
Rate for Payer: Health Net of AZ Medicare	$13.16
Rate for Payer: Humana of AZ Medicare	$7.52
Rate for Payer: Self Pay Self Pay	$37.60
Rate for Payer: TriWest Medicare	$7.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$27.40
Rate for Payer: UnitedHealth Group of AZ Medicare	$8.46

Bill Only Antigen Testing

Facility

$237.00

Service Code	CPT 86903
Hospital Charge Code	1807550
Hospital Revenue Code	302
Min. Negotiated Rate	$37.92
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Aetna of AZ Medicare	$66.36
Rate for Payer: Allwell Medicare	$37.92
Rate for Payer: Amerigroup Medicare	$37.92
Rate for Payer: APIPA Medicare/Medicaid	$88.52
Rate for Payer: AZCH Complete Medicare	$37.92
Rate for Payer: Banner UC Health Medicare	$37.92
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$161.16
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cigna of AZ Commercial	$154.05
Rate for Payer: Copperpoint Commercial	$58.66
Rate for Payer: Health Net of AZ Commercial	$142.20
Rate for Payer: Health Net of AZ Medicare	$66.36
Rate for Payer: Humana of AZ Medicare	$37.92
Rate for Payer: Self Pay Self Pay	$189.60
Rate for Payer: TriWest Medicare	$37.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$138.17
Rate for Payer: UnitedHealth Group of AZ Medicare	$42.66

Bill Only Antigen Testing

Facility

$237.00

Service Code	CPT 86903
Hospital Charge Code	1807550
Hospital Revenue Code	302
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$213.30
Rate for Payer: Aetna of AZ Commercial	$213.30
Rate for Payer: Bisbee Police All Plans	$61.62
Rate for Payer: Cash Price	$189.60
Rate for Payer: Self Pay Self Pay	$189.60

Bill Organic Acid Analysis

Facility

$284.00

Service Code	CPT 83919
Hospital Charge Code	23568395
Hospital Revenue Code	301
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Aetna of AZ Medicare	$79.52
Rate for Payer: Allwell Medicare	$45.44
Rate for Payer: Amerigroup Medicare	$45.44
Rate for Payer: APIPA Medicare/Medicaid	$106.07
Rate for Payer: AZCH Complete Medicare	$45.44
Rate for Payer: Banner UC Health Medicare	$45.44
Rate for Payer: Bisbee Police All Plans	$73.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$193.12
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cigna of AZ Commercial	$184.60
Rate for Payer: Copperpoint Commercial	$70.29
Rate for Payer: Health Net of AZ Commercial	$170.40
Rate for Payer: Health Net of AZ Medicare	$79.52
Rate for Payer: Humana of AZ Medicare	$45.44
Rate for Payer: Self Pay Self Pay	$227.20
Rate for Payer: TriWest Medicare	$45.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$165.57
Rate for Payer: UnitedHealth Group of AZ Medicare	$51.12

Bill Organic Acid Analysis

Facility

$284.00

Service Code	CPT 83919
Hospital Charge Code	23568395
Hospital Revenue Code	301
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna of AZ Commercial	$255.60
Rate for Payer: Bisbee Police All Plans	$73.84
Rate for Payer: Cash Price	$227.20
Rate for Payer: Self Pay Self Pay	$227.20

Bill PROCALCITONIN (PCT)

Facility

$200.00

Service Code	CPT 84145
Hospital Charge Code	23568450
Hospital Revenue Code	301
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Aetna of AZ Medicare	$56.00
Rate for Payer: Allwell Medicare	$32.00
Rate for Payer: Amerigroup Medicare	$32.00
Rate for Payer: APIPA Medicare/Medicaid	$74.70
Rate for Payer: AZCH Complete Medicare	$32.00
Rate for Payer: Banner UC Health Medicare	$32.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$136.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cigna of AZ Commercial	$130.00
Rate for Payer: Copperpoint Commercial	$49.50
Rate for Payer: Health Net of AZ Commercial	$120.00
Rate for Payer: Health Net of AZ Medicare	$56.00
Rate for Payer: Humana of AZ Medicare	$32.00
Rate for Payer: Self Pay Self Pay	$160.00
Rate for Payer: TriWest Medicare	$32.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$116.60
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.00

Bill PROCALCITONIN (PCT)

Facility

$200.00

Service Code	CPT 84145
Hospital Charge Code	23568450
Hospital Revenue Code	301
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna of AZ Commercial	$180.00
Rate for Payer: Bisbee Police All Plans	$52.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Self Pay Self Pay	$160.00

Bill Venous Draw

Facility

$41.00

Service Code	CPT 36415
Hospital Charge Code	16751369
Hospital Revenue Code	300
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

Bill Venous Draw

Facility

$41.00

Service Code	CPT 36415
Hospital Charge Code	16751369
Hospital Revenue Code	300
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

BINDER ABDOMINAL 10-IN UNIV

Facility

$42.00

Service Code	CPT A4462
Hospital Charge Code	22354188
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
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	$6.72
Rate for Payer: Amerigroup Medicare	$6.72
Rate for Payer: APIPA Medicare/Medicaid	$15.69
Rate for Payer: AZCH Complete Medicare	$6.72
Rate for Payer: Banner UC Health Medicare	$6.72
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	$10.39
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	$6.72
Rate for Payer: Self Pay Self Pay	$33.60
Rate for Payer: TriWest Medicare	$6.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$24.49
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.56

BINDER ABDOMINAL 10-IN UNIV

Facility

$42.00

Service Code	CPT A4462
Hospital Charge Code	22354188
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

BINDER ABDOMINAL 9-IN UNIV

Facility

$97.00

Service Code	CPT A4462
Hospital Charge Code	22354274
Hospital Revenue Code	270
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Aetna of AZ Medicare	$27.16
Rate for Payer: Allwell Medicare	$15.52
Rate for Payer: Amerigroup Medicare	$15.52
Rate for Payer: APIPA Medicare/Medicaid	$36.23
Rate for Payer: AZCH Complete Medicare	$15.52
Rate for Payer: Banner UC Health Medicare	$15.52
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$65.96
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cigna of AZ Commercial	$67.90
Rate for Payer: Copperpoint Commercial	$24.01
Rate for Payer: Health Net of AZ Commercial	$58.20
Rate for Payer: Health Net of AZ Medicare	$27.16
Rate for Payer: Humana of AZ Medicare	$15.52
Rate for Payer: Self Pay Self Pay	$77.60
Rate for Payer: TriWest Medicare	$15.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$56.55
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.46

BINDER ABDOMINAL 9-IN UNIV

Facility

$97.00

Service Code	CPT A4462
Hospital Charge Code	22354274
Hospital Revenue Code	270
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna of AZ Commercial	$87.30
Rate for Payer: Bisbee Police All Plans	$25.22
Rate for Payer: Cash Price	$77.60
Rate for Payer: Self Pay Self Pay	$77.60

Biopsy mucosa

Facility

$357.00

Service Code	CPT 57100
Hospital Charge Code	27267837
Hospital Revenue Code	360
Min. Negotiated Rate	$92.82
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Cash Price	$285.60
Rate for Payer: Self Pay Self Pay	$285.60

Biopsy mucosa

Facility

$357.00

Service Code	CPT 57100
Hospital Charge Code	27267837
Hospital Revenue Code	360
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$321.30
Rate for Payer: Aetna of AZ Medicare	$99.96
Rate for Payer: AHCCCS Medicaid	$459.22
Rate for Payer: Allwell Medicaid	$459.22
Rate for Payer: Allwell Medicare	$57.12
Rate for Payer: Amerigroup Medicare	$57.12
Rate for Payer: APIPA Medicare/Medicaid	$133.34
Rate for Payer: AZCH Complete Medicaid	$459.22
Rate for Payer: AZCH Complete Medicare	$57.12
Rate for Payer: Banner UC Health Medicaid	$459.22
Rate for Payer: Banner UC Health Medicare	$57.12
Rate for Payer: Bisbee Police All Plans	$92.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$242.76
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cigna of AZ Commercial	$178.50
Rate for Payer: Copperpoint Commercial	$88.36
Rate for Payer: Health Net of AZ Commercial	$214.20
Rate for Payer: Health Net of AZ Medicare	$99.96
Rate for Payer: Humana of AZ Medicare	$57.12
Rate for Payer: Mercy Care Medicaid	$459.22
Rate for Payer: Self Pay Self Pay	$285.60
Rate for Payer: TriWest Medicare	$57.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$64.26

Biopsy mucosa with suturing

Facility

$772.00

Service Code	CPT 57105
Hospital Charge Code	27291809
Hospital Revenue Code	360
Min. Negotiated Rate	$123.52
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Aetna of AZ Medicare	$216.16
Rate for Payer: AHCCCS Medicaid	$1,901.83
Rate for Payer: Allwell Medicaid	$1,901.83
Rate for Payer: Allwell Medicare	$123.52
Rate for Payer: Amerigroup Medicare	$123.52
Rate for Payer: APIPA Medicare/Medicaid	$288.34
Rate for Payer: AZCH Complete Medicaid	$1,901.83
Rate for Payer: AZCH Complete Medicare	$123.52
Rate for Payer: Banner UC Health Medicaid	$1,901.83
Rate for Payer: Banner UC Health Medicare	$123.52
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$524.96
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cash Price	$617.60
Rate for Payer: Cigna of AZ Commercial	$386.00
Rate for Payer: Copperpoint Commercial	$191.07
Rate for Payer: Health Net of AZ Commercial	$463.20
Rate for Payer: Health Net of AZ Medicare	$216.16
Rate for Payer: Humana of AZ Medicare	$123.52
Rate for Payer: Mercy Care Medicaid	$1,901.83
Rate for Payer: Self Pay Self Pay	$617.60
Rate for Payer: TriWest Medicare	$123.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.96

Biopsy mucosa with suturing

Facility

$772.00

Service Code	CPT 57105
Hospital Charge Code	27291809
Hospital Revenue Code	360
Min. Negotiated Rate	$200.72
Max. Negotiated Rate	$694.80
Rate for Payer: Aetna of AZ Commercial	$694.80
Rate for Payer: Bisbee Police All Plans	$200.72
Rate for Payer: Cash Price	$617.60
Rate for Payer: Self Pay Self Pay	$617.60

BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PR

Facility

$307.00

Service Code	CPT 11755
Hospital Charge Code	24049514
Hospital Revenue Code	360
Min. Negotiated Rate	$79.82
Max. Negotiated Rate	$276.30
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Bisbee Police All Plans	$79.82
Rate for Payer: Cash Price	$245.60
Rate for Payer: Self Pay Self Pay	$245.60

BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PR

Facility

$307.00

Service Code	CPT 11755
Hospital Charge Code	24049514
Hospital Revenue Code	360
Min. Negotiated Rate	$49.12
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$276.30
Rate for Payer: Aetna of AZ Medicare	$85.96
Rate for Payer: AHCCCS Medicaid	$450.93
Rate for Payer: Allwell Medicaid	$450.93
Rate for Payer: Allwell Medicare	$49.12
Rate for Payer: Amerigroup Medicare	$49.12
Rate for Payer: APIPA Medicare/Medicaid	$114.66
Rate for Payer: AZCH Complete Medicaid	$450.93
Rate for Payer: AZCH Complete Medicare	$49.12
Rate for Payer: Banner UC Health Medicaid	$450.93
Rate for Payer: Banner UC Health Medicare	$49.12
Rate for Payer: Bisbee Police All Plans	$79.82
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$208.76
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cash Price	$245.60
Rate for Payer: Cigna of AZ Commercial	$153.50
Rate for Payer: Copperpoint Commercial	$75.98
Rate for Payer: Health Net of AZ Commercial	$184.20
Rate for Payer: Health Net of AZ Medicare	$85.96
Rate for Payer: Humana of AZ Medicare	$49.12
Rate for Payer: Mercy Care Medicaid	$450.93
Rate for Payer: Self Pay Self Pay	$245.60
Rate for Payer: TriWest Medicare	$49.12
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$55.26

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$532.00
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Aetna of AZ Medicare	$931.00
Rate for Payer: AHCCCS Medicaid	$586.96
Rate for Payer: Allwell Medicaid	$586.96
Rate for Payer: Allwell Medicare	$532.00
Rate for Payer: Amerigroup Medicare	$532.00
Rate for Payer: APIPA Medicare/Medicaid	$1,241.89
Rate for Payer: AZCH Complete Medicaid	$586.96
Rate for Payer: AZCH Complete Medicare	$532.00
Rate for Payer: Banner UC Health Medicaid	$586.96
Rate for Payer: Banner UC Health Medicare	$532.00
Rate for Payer: Bisbee Police All Plans	$864.50
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,261.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Cigna of AZ Commercial	$2,327.50
Rate for Payer: Copperpoint Commercial	$822.94
Rate for Payer: Health Net of AZ Commercial	$1,995.00
Rate for Payer: Health Net of AZ Medicare	$931.00
Rate for Payer: Humana of AZ Medicare	$532.00
Rate for Payer: Mercy Care Medicaid	$586.96
Rate for Payer: Self Pay Self Pay	$2,660.00
Rate for Payer: TriWest Medicare	$532.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$598.50

BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL U

Facility

$3,325.00

Service Code	CPT 43239
Hospital Charge Code	23598978
Hospital Revenue Code	750
Min. Negotiated Rate	$864.50
Max. Negotiated Rate	$2,992.50
Rate for Payer: Aetna of AZ Commercial	$2,992.50
Rate for Payer: Bisbee Police All Plans	$864.50
Rate for Payer: Cash Price	$2,660.00
Rate for Payer: Self Pay Self Pay	$2,660.00

BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY A

Facility

$676.00

Service Code	CPT 55700
Hospital Charge Code	27883521
Hospital Revenue Code	360
Min. Negotiated Rate	$108.16
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$608.40
Rate for Payer: Aetna of AZ Medicare	$189.28
Rate for Payer: AHCCCS Medicaid	$1,299.92
Rate for Payer: Allwell Medicaid	$1,299.92
Rate for Payer: Allwell Medicare	$108.16
Rate for Payer: Amerigroup Medicare	$108.16
Rate for Payer: APIPA Medicare/Medicaid	$252.49
Rate for Payer: AZCH Complete Medicaid	$1,299.92
Rate for Payer: AZCH Complete Medicare	$108.16
Rate for Payer: Banner UC Health Medicaid	$1,299.92
Rate for Payer: Banner UC Health Medicare	$108.16
Rate for Payer: Bisbee Police All Plans	$175.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$459.68
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cash Price	$540.80
Rate for Payer: Cigna of AZ Commercial	$338.00
Rate for Payer: Copperpoint Commercial	$167.31
Rate for Payer: Health Net of AZ Commercial	$405.60
Rate for Payer: Health Net of AZ Medicare	$189.28
Rate for Payer: Humana of AZ Medicare	$108.16
Rate for Payer: Mercy Care Medicaid	$1,299.92
Rate for Payer: Self Pay Self Pay	$540.80
Rate for Payer: TriWest Medicare	$108.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$121.68

Know your out-of-pocket cost for care.

All Charges