Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

CYSTINE 24HR

Facility

$283.00

Service Code	CPT 82131
Hospital Charge Code	22481472
Hospital Revenue Code	301
Min. Negotiated Rate	$45.28
Max. Negotiated Rate	$254.70
Rate for Payer: Aetna of AZ Commercial	$254.70
Rate for Payer: Aetna of AZ Medicare	$79.24
Rate for Payer: Allwell Medicare	$45.28
Rate for Payer: Amerigroup Medicare	$45.28
Rate for Payer: APIPA Medicare/Medicaid	$105.70
Rate for Payer: AZCH Complete Medicare	$45.28
Rate for Payer: Banner UC Health Medicare	$45.28
Rate for Payer: Bisbee Police All Plans	$73.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$192.44
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cigna of AZ Commercial	$183.95
Rate for Payer: Copperpoint Commercial	$70.04
Rate for Payer: Health Net of AZ Commercial	$169.80
Rate for Payer: Health Net of AZ Medicare	$79.24
Rate for Payer: Humana of AZ Medicare	$45.28
Rate for Payer: Self Pay Self Pay	$226.40
Rate for Payer: TriWest Medicare	$45.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$164.99
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.94

Cystometrogram- Complex

Facility

$1,649.00

Service Code	CPT 51726
Hospital Charge Code	27267786
Hospital Revenue Code	360
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,484.10
Rate for Payer: Aetna of AZ Medicare	$461.72
Rate for Payer: AHCCCS Medicaid	$192.95
Rate for Payer: Allwell Medicaid	$192.95
Rate for Payer: Allwell Medicare	$263.84
Rate for Payer: Amerigroup Medicare	$263.84
Rate for Payer: APIPA Medicare/Medicaid	$615.90
Rate for Payer: AZCH Complete Medicaid	$192.95
Rate for Payer: AZCH Complete Medicare	$263.84
Rate for Payer: Banner UC Health Medicaid	$192.95
Rate for Payer: Banner UC Health Medicare	$263.84
Rate for Payer: Bisbee Police All Plans	$428.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,121.32
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Cigna of AZ Commercial	$824.50
Rate for Payer: Copperpoint Commercial	$408.13
Rate for Payer: Health Net of AZ Commercial	$989.40
Rate for Payer: Health Net of AZ Medicare	$461.72
Rate for Payer: Humana of AZ Medicare	$263.84
Rate for Payer: Mercy Care Medicaid	$192.95
Rate for Payer: Self Pay Self Pay	$1,319.20
Rate for Payer: TriWest Medicare	$263.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$296.82

Cystometrogram- Complex

Facility

$1,649.00

Service Code	CPT 51726
Hospital Charge Code	27267786
Hospital Revenue Code	360
Min. Negotiated Rate	$428.74
Max. Negotiated Rate	$1,484.10
Rate for Payer: Aetna of AZ Commercial	$1,484.10
Rate for Payer: Bisbee Police All Plans	$428.74
Rate for Payer: Cash Price	$1,319.20
Rate for Payer: Self Pay Self Pay	$1,319.20

Cystometrogram-Simple

Facility

$1,234.00

Service Code	CPT 51725
Hospital Charge Code	27267785
Hospital Revenue Code	360
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$2,161.00
Rate for Payer: Aetna of AZ Commercial	$1,110.60
Rate for Payer: Aetna of AZ Medicare	$345.52
Rate for Payer: AHCCCS Medicaid	$192.95
Rate for Payer: Allwell Medicaid	$192.95
Rate for Payer: Allwell Medicare	$197.44
Rate for Payer: Amerigroup Medicare	$197.44
Rate for Payer: APIPA Medicare/Medicaid	$460.90
Rate for Payer: AZCH Complete Medicaid	$192.95
Rate for Payer: AZCH Complete Medicare	$197.44
Rate for Payer: Banner UC Health Medicaid	$192.95
Rate for Payer: Banner UC Health Medicare	$197.44
Rate for Payer: Bisbee Police All Plans	$320.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$839.12
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cash Price	$987.20
Rate for Payer: Cigna of AZ Commercial	$617.00
Rate for Payer: Copperpoint Commercial	$305.42
Rate for Payer: Health Net of AZ Commercial	$740.40
Rate for Payer: Health Net of AZ Medicare	$345.52
Rate for Payer: Humana of AZ Medicare	$197.44
Rate for Payer: Mercy Care Medicaid	$192.95
Rate for Payer: Self Pay Self Pay	$987.20
Rate for Payer: TriWest Medicare	$197.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,161.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$222.12

Cystometrogram-Simple

Facility

$1,234.00

Service Code	CPT 51725
Hospital Charge Code	27267785
Hospital Revenue Code	360
Min. Negotiated Rate	$320.84
Max. Negotiated Rate	$1,110.60
Rate for Payer: Aetna of AZ Commercial	$1,110.60
Rate for Payer: Bisbee Police All Plans	$320.84
Rate for Payer: Cash Price	$987.20
Rate for Payer: Self Pay Self Pay	$987.20

Cystorrhaphy suture baldder inury simple

Facility

$4,037.00

Service Code	CPT 51860
Hospital Charge Code	27267818
Hospital Revenue Code	360
Min. Negotiated Rate	$1,049.62
Max. Negotiated Rate	$3,633.30
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Bisbee Police All Plans	$1,049.62
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Self Pay Self Pay	$3,229.60

Cystorrhaphy suture baldder inury simple

Facility

$4,037.00

Service Code	CPT 51860
Hospital Charge Code	27267818
Hospital Revenue Code	360
Min. Negotiated Rate	$645.92
Max. Negotiated Rate	$5,987.14
Rate for Payer: Aetna of AZ Commercial	$3,633.30
Rate for Payer: Aetna of AZ Medicare	$1,130.36
Rate for Payer: AHCCCS Medicaid	$5,987.14
Rate for Payer: Allwell Medicaid	$5,987.14
Rate for Payer: Allwell Medicare	$645.92
Rate for Payer: Amerigroup Medicare	$645.92
Rate for Payer: APIPA Medicare/Medicaid	$1,507.82
Rate for Payer: AZCH Complete Medicaid	$5,987.14
Rate for Payer: AZCH Complete Medicare	$645.92
Rate for Payer: Banner UC Health Medicaid	$5,987.14
Rate for Payer: Banner UC Health Medicare	$645.92
Rate for Payer: Bisbee Police All Plans	$1,049.62
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$2,745.16
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cigna of AZ Commercial	$2,018.50
Rate for Payer: Copperpoint Commercial	$999.16
Rate for Payer: Health Net of AZ Commercial	$2,422.20
Rate for Payer: Health Net of AZ Medicare	$1,130.36
Rate for Payer: Humana of AZ Medicare	$645.92
Rate for Payer: Mercy Care Medicaid	$5,987.14
Rate for Payer: Self Pay Self Pay	$3,229.60
Rate for Payer: TriWest Medicare	$645.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$726.66

Cystorrhaphy suture ballder injury complicated

Facility

$4,862.00

Service Code	CPT 51865
Hospital Charge Code	27291795
Hospital Revenue Code	360
Min. Negotiated Rate	$777.92
Max. Negotiated Rate	$4,375.80
Rate for Payer: Aetna of AZ Commercial	$4,375.80
Rate for Payer: Aetna of AZ Medicare	$1,361.36
Rate for Payer: Allwell Medicare	$777.92
Rate for Payer: Amerigroup Medicare	$777.92
Rate for Payer: APIPA Medicare/Medicaid	$1,815.96
Rate for Payer: AZCH Complete Medicare	$777.92
Rate for Payer: Banner UC Health Medicare	$777.92
Rate for Payer: Bisbee Police All Plans	$1,264.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$3,306.16
Rate for Payer: Cash Price	$3,889.60
Rate for Payer: Cash Price	$3,889.60
Rate for Payer: Cigna of AZ Commercial	$2,431.00
Rate for Payer: Copperpoint Commercial	$1,203.35
Rate for Payer: Health Net of AZ Commercial	$2,917.20
Rate for Payer: Health Net of AZ Medicare	$1,361.36
Rate for Payer: Humana of AZ Medicare	$777.92
Rate for Payer: Self Pay Self Pay	$3,889.60
Rate for Payer: TriWest Medicare	$777.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,914.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$875.16

Cystorrhaphy suture ballder injury complicated

Facility

$4,862.00

Service Code	CPT 51865
Hospital Charge Code	27291795
Hospital Revenue Code	360
Min. Negotiated Rate	$1,264.12
Max. Negotiated Rate	$4,375.80
Rate for Payer: Aetna of AZ Commercial	$4,375.80
Rate for Payer: Bisbee Police All Plans	$1,264.12
Rate for Payer: Cash Price	$3,889.60
Rate for Payer: Self Pay Self Pay	$3,889.60

CYSTOSCOPY

Facility

$1,713.00

Service Code	CPT 52000
Hospital Charge Code	885909
Hospital Revenue Code	750
Min. Negotiated Rate	$445.38
Max. Negotiated Rate	$1,541.70
Rate for Payer: Aetna of AZ Commercial	$1,541.70
Rate for Payer: Bisbee Police All Plans	$445.38
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Self Pay Self Pay	$1,370.40

CYSTOSCOPY

Facility

$1,713.00

Service Code	CPT 52000
Hospital Charge Code	885909
Hospital Revenue Code	750
Min. Negotiated Rate	$274.08
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$1,541.70
Rate for Payer: Aetna of AZ Medicare	$479.64
Rate for Payer: AHCCCS Medicaid	$416.71
Rate for Payer: Allwell Medicaid	$416.71
Rate for Payer: Allwell Medicare	$274.08
Rate for Payer: Amerigroup Medicare	$274.08
Rate for Payer: APIPA Medicare/Medicaid	$639.81
Rate for Payer: AZCH Complete Medicaid	$416.71
Rate for Payer: AZCH Complete Medicare	$274.08
Rate for Payer: Banner UC Health Medicaid	$416.71
Rate for Payer: Banner UC Health Medicare	$274.08
Rate for Payer: Bisbee Police All Plans	$445.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,164.84
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Cigna of AZ Commercial	$1,199.10
Rate for Payer: Copperpoint Commercial	$423.97
Rate for Payer: Health Net of AZ Commercial	$1,027.80
Rate for Payer: Health Net of AZ Medicare	$479.64
Rate for Payer: Humana of AZ Medicare	$274.08
Rate for Payer: Mercy Care Medicaid	$416.71
Rate for Payer: Self Pay Self Pay	$1,370.40
Rate for Payer: TriWest Medicare	$274.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$308.34

Cystoscopy and Biopsy

Facility

$761.00

Service Code	CPT 52204
Hospital Charge Code	27281885
Hospital Revenue Code	360
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

Cystoscopy and Biopsy

Facility

$761.00

Service Code	CPT 52204
Hospital Charge Code	27281885
Hospital Revenue Code	360
Min. Negotiated Rate	$121.76
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$684.90
Rate for Payer: Aetna of AZ Medicare	$213.08
Rate for Payer: AHCCCS Medicaid	$1,299.92
Rate for Payer: Allwell Medicaid	$1,299.92
Rate for Payer: Allwell Medicare	$121.76
Rate for Payer: Amerigroup Medicare	$121.76
Rate for Payer: APIPA Medicare/Medicaid	$284.23
Rate for Payer: AZCH Complete Medicaid	$1,299.92
Rate for Payer: AZCH Complete Medicare	$121.76
Rate for Payer: Banner UC Health Medicaid	$1,299.92
Rate for Payer: Banner UC Health Medicare	$121.76
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	$380.50
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	$121.76
Rate for Payer: Mercy Care Medicaid	$1,299.92
Rate for Payer: Self Pay Self Pay	$608.80
Rate for Payer: TriWest Medicare	$121.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$3,373.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$136.98

CYSTOSCOPY INJ NEEDLE WILIAMS -COOK

Facility

$148.00

Hospital Charge Code	22354216
Hospital Revenue Code	270
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Cash Price	$118.40
Rate for Payer: Self Pay Self Pay	$118.40

CYSTOSCOPY INJ NEEDLE WILIAMS -COOK

Facility

$148.00

Hospital Charge Code	22354216
Hospital Revenue Code	270
Min. Negotiated Rate	$23.68
Max. Negotiated Rate	$133.20
Rate for Payer: Aetna of AZ Commercial	$133.20
Rate for Payer: Aetna of AZ Medicare	$41.44
Rate for Payer: Allwell Medicare	$23.68
Rate for Payer: Amerigroup Medicare	$23.68
Rate for Payer: APIPA Medicare/Medicaid	$55.28
Rate for Payer: AZCH Complete Medicare	$23.68
Rate for Payer: Banner UC Health Medicare	$23.68
Rate for Payer: Bisbee Police All Plans	$38.48
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$100.64
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cigna of AZ Commercial	$103.60
Rate for Payer: Copperpoint Commercial	$36.63
Rate for Payer: Health Net of AZ Commercial	$88.80
Rate for Payer: Health Net of AZ Medicare	$41.44
Rate for Payer: Humana of AZ Medicare	$23.68
Rate for Payer: Self Pay Self Pay	$118.40
Rate for Payer: TriWest Medicare	$23.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$86.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$26.64

Cystoscopy w/hydrodistension for IC

Facility

$1,134.00

Service Code	CPT 52260
Hospital Charge Code	27281909
Hospital Revenue Code	360
Min. Negotiated Rate	$294.84
Max. Negotiated Rate	$1,020.60
Rate for Payer: Aetna of AZ Commercial	$1,020.60
Rate for Payer: Bisbee Police All Plans	$294.84
Rate for Payer: Cash Price	$907.20
Rate for Payer: Self Pay Self Pay	$907.20

Cystoscopy w/hydrodistension for IC

Facility

$1,134.00

Service Code	CPT 52260
Hospital Charge Code	27281909
Hospital Revenue Code	360
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$1,020.60
Rate for Payer: Aetna of AZ Medicare	$317.52
Rate for Payer: AHCCCS Medicaid	$1,299.92
Rate for Payer: Allwell Medicaid	$1,299.92
Rate for Payer: Allwell Medicare	$181.44
Rate for Payer: Amerigroup Medicare	$181.44
Rate for Payer: APIPA Medicare/Medicaid	$423.55
Rate for Payer: AZCH Complete Medicaid	$1,299.92
Rate for Payer: AZCH Complete Medicare	$181.44
Rate for Payer: Banner UC Health Medicaid	$1,299.92
Rate for Payer: Banner UC Health Medicare	$181.44
Rate for Payer: Bisbee Police All Plans	$294.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$771.12
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cigna of AZ Commercial	$567.00
Rate for Payer: Copperpoint Commercial	$280.67
Rate for Payer: Health Net of AZ Commercial	$680.40
Rate for Payer: Health Net of AZ Medicare	$317.52
Rate for Payer: Humana of AZ Medicare	$181.44
Rate for Payer: Mercy Care Medicaid	$1,299.92
Rate for Payer: Self Pay Self Pay	$907.20
Rate for Payer: TriWest Medicare	$181.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,909.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$204.12

Cystoscopy w/irrigation clots

Facility

$1,549.00

Service Code	CPT 52001
Hospital Charge Code	27291811
Hospital Revenue Code	360
Min. Negotiated Rate	$247.84
Max. Negotiated Rate	$2,909.00
Rate for Payer: Aetna of AZ Commercial	$1,394.10
Rate for Payer: Aetna of AZ Medicare	$433.72
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$247.84
Rate for Payer: Amerigroup Medicare	$247.84
Rate for Payer: APIPA Medicare/Medicaid	$578.55
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$247.84
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$247.84
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	$247.84
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$1,239.20
Rate for Payer: TriWest Medicare	$247.84
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	$384.80
Max. Negotiated Rate	$3,373.00
Rate for Payer: Aetna of AZ Commercial	$2,164.50
Rate for Payer: Aetna of AZ Medicare	$673.40
Rate for Payer: AHCCCS Medicaid	$2,230.35
Rate for Payer: Allwell Medicaid	$2,230.35
Rate for Payer: Allwell Medicare	$384.80
Rate for Payer: Amerigroup Medicare	$384.80
Rate for Payer: APIPA Medicare/Medicaid	$898.27
Rate for Payer: AZCH Complete Medicaid	$2,230.35
Rate for Payer: AZCH Complete Medicare	$384.80
Rate for Payer: Banner UC Health Medicaid	$2,230.35
Rate for Payer: Banner UC Health Medicare	$384.80
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	$384.80
Rate for Payer: Mercy Care Medicaid	$2,230.35
Rate for Payer: Self Pay Self Pay	$1,924.00
Rate for Payer: TriWest Medicare	$384.80
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	$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

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	$435.20
Max. Negotiated Rate	$2,507.00
Rate for Payer: Aetna of AZ Commercial	$2,448.00
Rate for Payer: Aetna of AZ Medicare	$761.60
Rate for Payer: AHCCCS Medicaid	$1,299.92
Rate for Payer: Allwell Medicaid	$1,299.92
Rate for Payer: Allwell Medicare	$435.20
Rate for Payer: Amerigroup Medicare	$435.20
Rate for Payer: APIPA Medicare/Medicaid	$1,015.92
Rate for Payer: AZCH Complete Medicaid	$1,299.92
Rate for Payer: AZCH Complete Medicare	$435.20
Rate for Payer: Banner UC Health Medicaid	$1,299.92
Rate for Payer: Banner UC Health Medicare	$435.20
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	$435.20
Rate for Payer: Mercy Care Medicaid	$1,299.92
Rate for Payer: Self Pay Self Pay	$2,176.00
Rate for Payer: TriWest Medicare	$435.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$2,507.00
Rate for Payer: UnitedHealth Group of AZ Medicare	$489.60

Cytomegalovirus (CMV) Ab, IgG LC

Facility

$219.00

Service Code	CPT 86644
Hospital Charge Code	2029259
Hospital Revenue Code	302
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Aetna of AZ Medicare	$61.32
Rate for Payer: Allwell Medicare	$35.04
Rate for Payer: Amerigroup Medicare	$35.04
Rate for Payer: APIPA Medicare/Medicaid	$81.80
Rate for Payer: AZCH Complete Medicare	$35.04
Rate for Payer: Banner UC Health Medicare	$35.04
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$148.92
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cigna of AZ Commercial	$142.35
Rate for Payer: Copperpoint Commercial	$54.20
Rate for Payer: Health Net of AZ Commercial	$131.40
Rate for Payer: Health Net of AZ Medicare	$61.32
Rate for Payer: Humana of AZ Medicare	$35.04
Rate for Payer: Self Pay Self Pay	$175.20
Rate for Payer: TriWest Medicare	$35.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$127.68
Rate for Payer: UnitedHealth Group of AZ Medicare	$39.42

Cytomegalovirus (CMV) Ab, IgG LC

Facility

$219.00

Service Code	CPT 86644
Hospital Charge Code	2029259
Hospital Revenue Code	302
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$197.10
Rate for Payer: Aetna of AZ Commercial	$197.10
Rate for Payer: Bisbee Police All Plans	$56.94
Rate for Payer: Cash Price	$175.20
Rate for Payer: Self Pay Self Pay	$175.20

Know your out-of-pocket cost for care.

All Charges