Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Cystoscopy w/irrigation clots

Facility

$1,549.00

Service Code	CPT 52001
Hospital Charge Code	27291811
Hospital Revenue Code	360
Min. Negotiated Rate	$232.35
Max. Negotiated Rate	$4,460.70
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Aetna of AZ Medicare	$433.72
Rate for Payer: AHCCCS Medicaid	$4,460.70
Rate for Payer: Allwell Medicaid	$4,460.70
Rate for Payer: Allwell Medicare	$232.35
Rate for Payer: Amerigroup Medicare	$232.35
Rate for Payer: APIPA Medicare/Medicaid	$578.55
Rate for Payer: AZCH Complete Medicaid	$4,460.70
Rate for Payer: AZCH Complete Medicare	$232.35
Rate for Payer: Banner UC Health Medicaid	$4,460.70
Rate for Payer: Banner UC Health Medicare	$232.35
Rate for Payer: Bisbee Police All Plans	$402.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,053.32
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Cigna of AZ Commercial	$774.50
Rate for Payer: Copperpoint Commercial	$383.38
Rate for Payer: Health Net of AZ Commercial	$929.40
Rate for Payer: Health Net of AZ Medicare	$433.72
Rate for Payer: Humana of AZ Medicare	$232.35
Rate for Payer: Mercy Care Medicaid	$4,460.70
Rate for Payer: Self Pay Self Pay	$1,239.20
Rate for Payer: TriWest Medicare	$232.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$278.82

Cystoscopy w/irrigation clots

Facility

$1,549.00

Service Code	CPT 52001
Hospital Charge Code	27291811
Hospital Revenue Code	360
Min. Negotiated Rate	$402.74
Max. Negotiated Rate	$1,394.10
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Bisbee Police All Plans	$402.74
Rate for Payer: Cash Price	$1,239.20
Rate for Payer: Self Pay Self Pay	$1,239.20

Cystotomy closure

Facility

$2,405.00

Service Code	CPT 51880
Hospital Charge Code	27291794
Hospital Revenue Code	360
Min. Negotiated Rate	$625.30
Max. Negotiated Rate	$2,164.50
Rate for Payer: Aetna of AZ Commercial	$2,164.50
Rate for Payer: Bisbee Police All Plans	$625.30
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Self Pay Self Pay	$1,924.00

Cystotomy closure

Facility

$2,405.00

Service Code	CPT 51880
Hospital Charge Code	27291794
Hospital Revenue Code	360
Min. Negotiated Rate	$360.75
Max. Negotiated Rate	$4,460.70
Rate for Payer: Aetna of AZ Commercial	$2,164.50
Rate for Payer: Aetna of AZ Medicare	$673.40
Rate for Payer: AHCCCS Medicaid	$4,460.70
Rate for Payer: Allwell Medicaid	$4,460.70
Rate for Payer: Allwell Medicare	$360.75
Rate for Payer: Amerigroup Medicare	$360.75
Rate for Payer: APIPA Medicare/Medicaid	$898.27
Rate for Payer: AZCH Complete Medicaid	$4,460.70
Rate for Payer: AZCH Complete Medicare	$360.75
Rate for Payer: Banner UC Health Medicaid	$4,460.70
Rate for Payer: Banner UC Health Medicare	$360.75
Rate for Payer: Bisbee Police All Plans	$625.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,635.40
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cigna of AZ Commercial	$1,202.50
Rate for Payer: Copperpoint Commercial	$595.24
Rate for Payer: Health Net of AZ Commercial	$1,443.00
Rate for Payer: Health Net of AZ Medicare	$673.40
Rate for Payer: Humana of AZ Medicare	$360.75
Rate for Payer: Mercy Care Medicaid	$4,460.70
Rate for Payer: Self Pay Self Pay	$1,924.00
Rate for Payer: TriWest Medicare	$360.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$432.90

Cystotomy with insertion of ureteral stent

Facility

$2,720.00

Service Code	CPT 51045
Hospital Charge Code	27267817
Hospital Revenue Code	360
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$2,599.84
Rate for Payer: Aetna of AZ Commercial	$2,448.00
Rate for Payer: Aetna of AZ Medicare	$761.60
Rate for Payer: AHCCCS Medicaid	$2,599.84
Rate for Payer: Allwell Medicaid	$2,599.84
Rate for Payer: Allwell Medicare	$408.00
Rate for Payer: Amerigroup Medicare	$408.00
Rate for Payer: APIPA Medicare/Medicaid	$1,015.92
Rate for Payer: AZCH Complete Medicaid	$2,599.84
Rate for Payer: AZCH Complete Medicare	$408.00
Rate for Payer: Banner UC Health Medicaid	$2,599.84
Rate for Payer: Banner UC Health Medicare	$408.00
Rate for Payer: Bisbee Police All Plans	$707.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,849.60
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Cigna of AZ Commercial	$1,360.00
Rate for Payer: Copperpoint Commercial	$673.20
Rate for Payer: Health Net of AZ Commercial	$1,632.00
Rate for Payer: Health Net of AZ Medicare	$761.60
Rate for Payer: Humana of AZ Medicare	$408.00
Rate for Payer: Mercy Care Medicaid	$2,599.84
Rate for Payer: Self Pay Self Pay	$2,176.00
Rate for Payer: TriWest Medicare	$408.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$489.60

Cystotomy with insertion of ureteral stent

Facility

$2,720.00

Service Code	CPT 51045
Hospital Charge Code	27267817
Hospital Revenue Code	360
Min. Negotiated Rate	$707.20
Max. Negotiated Rate	$2,448.00
Rate for Payer: Aetna of AZ Commercial	$2,448.00
Rate for Payer: Bisbee Police All Plans	$707.20
Rate for Payer: Cash Price	$2,176.00
Rate for Payer: Self Pay Self Pay	$2,176.00

Cytomegalovirus (CMV) Ab, IgG LC

Facility

$230.00

Service Code	CPT 86644
Hospital Charge Code	2029259
Hospital Revenue Code	302
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Cash Price	$184.00
Rate for Payer: Self Pay Self Pay	$184.00

Cytomegalovirus (CMV) Ab, IgG LC

Facility

$230.00

Service Code	CPT 86644
Hospital Charge Code	2029259
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna of AZ Commercial	$207.00
Rate for Payer: Aetna of AZ Medicare	$64.40
Rate for Payer: AHCCCS Medicaid	$14.39
Rate for Payer: Allwell Medicaid	$14.39
Rate for Payer: Allwell Medicare	$34.50
Rate for Payer: Amerigroup Medicare	$34.50
Rate for Payer: APIPA Medicare/Medicaid	$85.90
Rate for Payer: AZCH Complete Medicaid	$14.39
Rate for Payer: AZCH Complete Medicare	$34.50
Rate for Payer: Banner UC Health Medicaid	$14.39
Rate for Payer: Banner UC Health Medicare	$34.50
Rate for Payer: Bisbee Police All Plans	$59.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$156.40
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna of AZ Commercial	$149.50
Rate for Payer: Copperpoint Commercial	$56.92
Rate for Payer: Health Net of AZ Commercial	$138.00
Rate for Payer: Health Net of AZ Medicare	$64.40
Rate for Payer: Humana of AZ Medicare	$34.50
Rate for Payer: Mercy Care Medicaid	$14.39
Rate for Payer: Self Pay Self Pay	$184.00
Rate for Payer: TriWest Medicare	$34.50
Rate for Payer: UnitedHealth Group of AZ Commercial	$134.09
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.40

Cytomegalovirus (CMV) Ab, IgM LC

Facility

$242.00

Service Code	CPT 86645
Hospital Charge Code	2029230
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
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: AHCCCS Medicaid	$16.85
Rate for Payer: Allwell Medicaid	$16.85
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 Medicaid	$16.85
Rate for Payer: AZCH Complete Medicare	$36.30
Rate for Payer: Banner UC Health Medicaid	$16.85
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: Cash Price	$193.60
Rate for Payer: Cigna of AZ Commercial	$157.30
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: Mercy Care Medicaid	$16.85
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

Cytomegalovirus (CMV) Ab, IgM LC

Facility

$242.00

Service Code	CPT 86645
Hospital Charge Code	2029230
Hospital Revenue Code	302
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

CYTOPATH CELL ENHANCE TECH

Facility

$186.00

Service Code	CPT 88112
Hospital Charge Code	22545729
Hospital Revenue Code	310
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Cash Price	$148.80
Rate for Payer: Self Pay Self Pay	$148.80

CYTOPATH CELL ENHANCE TECH

Facility

$186.00

Service Code	CPT 88112
Hospital Charge Code	22545729
Hospital Revenue Code	310
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$167.40
Rate for Payer: Aetna of AZ Commercial	$167.40
Rate for Payer: Aetna of AZ Medicare	$52.08
Rate for Payer: AHCCCS Medicaid	$36.08
Rate for Payer: Allwell Medicaid	$36.08
Rate for Payer: Allwell Medicare	$27.90
Rate for Payer: Amerigroup Medicare	$27.90
Rate for Payer: APIPA Medicare/Medicaid	$69.47
Rate for Payer: AZCH Complete Medicaid	$36.08
Rate for Payer: AZCH Complete Medicare	$27.90
Rate for Payer: Banner UC Health Medicaid	$36.08
Rate for Payer: Banner UC Health Medicare	$27.90
Rate for Payer: Bisbee Police All Plans	$48.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$126.48
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cigna of AZ Commercial	$120.90
Rate for Payer: Copperpoint Commercial	$46.04
Rate for Payer: Health Net of AZ Commercial	$111.60
Rate for Payer: Health Net of AZ Medicare	$52.08
Rate for Payer: Humana of AZ Medicare	$27.90
Rate for Payer: Mercy Care Medicaid	$36.08
Rate for Payer: Self Pay Self Pay	$148.80
Rate for Payer: TriWest Medicare	$27.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$108.44
Rate for Payer: UnitedHealth Group of AZ Medicare	$33.48

CYTOPATH CONCENTRATE TECH

Facility

$282.00

Service Code	CPT 88108
Hospital Charge Code	22545551
Hospital Revenue Code	310
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Aetna of AZ Medicare	$78.96
Rate for Payer: AHCCCS Medicaid	$24.53
Rate for Payer: Allwell Medicaid	$24.53
Rate for Payer: Allwell Medicare	$42.30
Rate for Payer: Amerigroup Medicare	$42.30
Rate for Payer: APIPA Medicare/Medicaid	$105.33
Rate for Payer: AZCH Complete Medicaid	$24.53
Rate for Payer: AZCH Complete Medicare	$42.30
Rate for Payer: Banner UC Health Medicaid	$24.53
Rate for Payer: Banner UC Health Medicare	$42.30
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.76
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cigna of AZ Commercial	$183.30
Rate for Payer: Copperpoint Commercial	$69.80
Rate for Payer: Health Net of AZ Commercial	$169.20
Rate for Payer: Health Net of AZ Medicare	$78.96
Rate for Payer: Humana of AZ Medicare	$42.30
Rate for Payer: Mercy Care Medicaid	$24.53
Rate for Payer: Self Pay Self Pay	$225.60
Rate for Payer: TriWest Medicare	$42.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.76

CYTOPATH CONCENTRATE TECH

Facility

$282.00

Service Code	CPT 88108
Hospital Charge Code	22545551
Hospital Revenue Code	310
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna of AZ Commercial	$253.80
Rate for Payer: Bisbee Police All Plans	$73.32
Rate for Payer: Cash Price	$225.60
Rate for Payer: Self Pay Self Pay	$225.60

CYTOPATH EVAL FNA REPORT

Facility

$379.00

Service Code	CPT 88173
Hospital Charge Code	22545710
Hospital Revenue Code	310
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Cash Price	$303.20
Rate for Payer: Self Pay Self Pay	$303.20

CYTOPATH EVAL FNA REPORT

Facility

$379.00

Service Code	CPT 88173
Hospital Charge Code	22545710
Hospital Revenue Code	310
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna of AZ Commercial	$341.10
Rate for Payer: Aetna of AZ Medicare	$106.12
Rate for Payer: AHCCCS Medicaid	$36.08
Rate for Payer: Allwell Medicaid	$36.08
Rate for Payer: Allwell Medicare	$56.85
Rate for Payer: Amerigroup Medicare	$56.85
Rate for Payer: APIPA Medicare/Medicaid	$141.56
Rate for Payer: AZCH Complete Medicaid	$36.08
Rate for Payer: AZCH Complete Medicare	$56.85
Rate for Payer: Banner UC Health Medicaid	$36.08
Rate for Payer: Banner UC Health Medicare	$56.85
Rate for Payer: Bisbee Police All Plans	$98.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$257.72
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cigna of AZ Commercial	$246.35
Rate for Payer: Copperpoint Commercial	$93.80
Rate for Payer: Health Net of AZ Commercial	$227.40
Rate for Payer: Health Net of AZ Medicare	$106.12
Rate for Payer: Humana of AZ Medicare	$56.85
Rate for Payer: Mercy Care Medicaid	$36.08
Rate for Payer: Self Pay Self Pay	$303.20
Rate for Payer: TriWest Medicare	$56.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$220.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$68.22

CYTOPATH FL NON GYN FILTER

Facility

$343.00

Service Code	CPT 88106
Hospital Charge Code	22545728
Hospital Revenue Code	310
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Cash Price	$274.40
Rate for Payer: Self Pay Self Pay	$274.40

CYTOPATH FL NON GYN FILTER

Facility

$343.00

Service Code	CPT 88106
Hospital Charge Code	22545728
Hospital Revenue Code	310
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna of AZ Commercial	$308.70
Rate for Payer: Aetna of AZ Medicare	$96.04
Rate for Payer: AHCCCS Medicaid	$17.89
Rate for Payer: Allwell Medicaid	$17.89
Rate for Payer: Allwell Medicare	$51.45
Rate for Payer: Amerigroup Medicare	$51.45
Rate for Payer: APIPA Medicare/Medicaid	$128.11
Rate for Payer: AZCH Complete Medicaid	$17.89
Rate for Payer: AZCH Complete Medicare	$51.45
Rate for Payer: Banner UC Health Medicaid	$17.89
Rate for Payer: Banner UC Health Medicare	$51.45
Rate for Payer: Bisbee Police All Plans	$89.18
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$233.24
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cigna of AZ Commercial	$222.95
Rate for Payer: Copperpoint Commercial	$84.89
Rate for Payer: Health Net of AZ Commercial	$205.80
Rate for Payer: Health Net of AZ Medicare	$96.04
Rate for Payer: Humana of AZ Medicare	$51.45
Rate for Payer: Mercy Care Medicaid	$17.89
Rate for Payer: Self Pay Self Pay	$274.40
Rate for Payer: TriWest Medicare	$51.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$199.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$61.74

CYTOPATH FL NON GYN SMEARS

Facility

$239.00

Service Code	CPT 88104
Hospital Charge Code	22545727
Hospital Revenue Code	310
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Aetna of AZ Medicare	$66.92
Rate for Payer: AHCCCS Medicaid	$24.53
Rate for Payer: Allwell Medicaid	$24.53
Rate for Payer: Allwell Medicare	$35.85
Rate for Payer: Amerigroup Medicare	$35.85
Rate for Payer: APIPA Medicare/Medicaid	$89.27
Rate for Payer: AZCH Complete Medicaid	$24.53
Rate for Payer: AZCH Complete Medicare	$35.85
Rate for Payer: Banner UC Health Medicaid	$24.53
Rate for Payer: Banner UC Health Medicare	$35.85
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$162.52
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cigna of AZ Commercial	$155.35
Rate for Payer: Copperpoint Commercial	$59.15
Rate for Payer: Health Net of AZ Commercial	$143.40
Rate for Payer: Health Net of AZ Medicare	$66.92
Rate for Payer: Humana of AZ Medicare	$35.85
Rate for Payer: Mercy Care Medicaid	$24.53
Rate for Payer: Self Pay Self Pay	$191.20
Rate for Payer: TriWest Medicare	$35.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$139.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$43.02

CYTOPATH FL NON GYN SMEARS

Facility

$239.00

Service Code	CPT 88104
Hospital Charge Code	22545727
Hospital Revenue Code	310
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$215.10
Rate for Payer: Aetna of AZ Commercial	$215.10
Rate for Payer: Bisbee Police All Plans	$62.14
Rate for Payer: Cash Price	$191.20
Rate for Payer: Self Pay Self Pay	$191.20

CYTOPATH SMEAR OTH SOURCE

Facility

$203.00

Service Code	CPT 88160
Hospital Charge Code	22545730
Hospital Revenue Code	310
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Cash Price	$162.40
Rate for Payer: Self Pay Self Pay	$162.40

CYTOPATH SMEAR OTH SOURCE

Facility

$203.00

Service Code	CPT 88160
Hospital Charge Code	22545730
Hospital Revenue Code	310
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna of AZ Commercial	$182.70
Rate for Payer: Aetna of AZ Medicare	$56.84
Rate for Payer: AHCCCS Medicaid	$17.89
Rate for Payer: Allwell Medicaid	$17.89
Rate for Payer: Allwell Medicare	$30.45
Rate for Payer: Amerigroup Medicare	$30.45
Rate for Payer: APIPA Medicare/Medicaid	$75.82
Rate for Payer: AZCH Complete Medicaid	$17.89
Rate for Payer: AZCH Complete Medicare	$30.45
Rate for Payer: Banner UC Health Medicaid	$17.89
Rate for Payer: Banner UC Health Medicare	$30.45
Rate for Payer: Bisbee Police All Plans	$52.78
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$138.04
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cigna of AZ Commercial	$131.95
Rate for Payer: Copperpoint Commercial	$50.24
Rate for Payer: Health Net of AZ Commercial	$121.80
Rate for Payer: Health Net of AZ Medicare	$56.84
Rate for Payer: Humana of AZ Medicare	$30.45
Rate for Payer: Mercy Care Medicaid	$17.89
Rate for Payer: Self Pay Self Pay	$162.40
Rate for Payer: TriWest Medicare	$30.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$118.35
Rate for Payer: UnitedHealth Group of AZ Medicare	$36.54

CYTOPATH SMEAR OTH SOURCE 2

Facility

$179.00

Service Code	CPT 88161
Hospital Charge Code	22545736
Hospital Revenue Code	310
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Cash Price	$143.20
Rate for Payer: Self Pay Self Pay	$143.20

CYTOPATH SMEAR OTH SOURCE 2

Facility

$179.00

Service Code	CPT 88161
Hospital Charge Code	22545736
Hospital Revenue Code	310
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$161.10
Rate for Payer: Aetna of AZ Commercial	$161.10
Rate for Payer: Aetna of AZ Medicare	$50.12
Rate for Payer: AHCCCS Medicaid	$17.89
Rate for Payer: Allwell Medicaid	$17.89
Rate for Payer: Allwell Medicare	$26.85
Rate for Payer: Amerigroup Medicare	$26.85
Rate for Payer: APIPA Medicare/Medicaid	$66.86
Rate for Payer: AZCH Complete Medicaid	$17.89
Rate for Payer: AZCH Complete Medicare	$26.85
Rate for Payer: Banner UC Health Medicaid	$17.89
Rate for Payer: Banner UC Health Medicare	$26.85
Rate for Payer: Bisbee Police All Plans	$46.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$121.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cigna of AZ Commercial	$116.35
Rate for Payer: Copperpoint Commercial	$44.30
Rate for Payer: Health Net of AZ Commercial	$107.40
Rate for Payer: Health Net of AZ Medicare	$50.12
Rate for Payer: Humana of AZ Medicare	$26.85
Rate for Payer: Mercy Care Medicaid	$17.89
Rate for Payer: Self Pay Self Pay	$143.20
Rate for Payer: TriWest Medicare	$26.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.22

CYTOPATH SMEAR OTH SOURCE 3

Facility

$297.00

Service Code	CPT 88162
Hospital Charge Code	22545737
Hospital Revenue Code	310
Min. Negotiated Rate	$77.22
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna of AZ Commercial	$267.30
Rate for Payer: Bisbee Police All Plans	$77.22
Rate for Payer: Cash Price	$237.60
Rate for Payer: Self Pay Self Pay	$237.60

Know your out-of-pocket cost for care.

All Charges