Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOB A

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481481
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IMMUNOGLOB A

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481481
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IMMUNOGLOB E

Facility

$206.00

Service Code	CPT 82785
Hospital Charge Code	22481482
Hospital Revenue Code	301
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Aetna of AZ Medicare	$57.68
Rate for Payer: Allwell Medicare	$32.96
Rate for Payer: Amerigroup Medicare	$32.96
Rate for Payer: APIPA Medicare/Medicaid	$76.94
Rate for Payer: AZCH Complete Medicare	$32.96
Rate for Payer: Banner UC Health Medicare	$32.96
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$140.08
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cigna of AZ Commercial	$133.90
Rate for Payer: Copperpoint Commercial	$50.98
Rate for Payer: Health Net of AZ Commercial	$123.60
Rate for Payer: Health Net of AZ Medicare	$57.68
Rate for Payer: Humana of AZ Medicare	$32.96
Rate for Payer: Self Pay Self Pay	$164.80
Rate for Payer: TriWest Medicare	$32.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$120.10
Rate for Payer: UnitedHealth Group of AZ Medicare	$37.08

IMMUNOGLOB E

Facility

$206.00

Service Code	CPT 82785
Hospital Charge Code	22481482
Hospital Revenue Code	301
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$185.40
Rate for Payer: Aetna of AZ Commercial	$185.40
Rate for Payer: Bisbee Police All Plans	$53.56
Rate for Payer: Cash Price	$164.80
Rate for Payer: Self Pay Self Pay	$164.80

IMMUNOGLOB G

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481483
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

IMMUNOGLOB G

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481483
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IMMUNOGLOB M

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481484
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IMMUNOGLOB M

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	22481484
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

Immunoglobulin A, Quant. Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	3658179
Hospital Revenue Code	301
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: Allwell Medicare	$18.24
Rate for Payer: Amerigroup Medicare	$18.24
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.21
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

Immunoglobulin A, Quant. Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	3658179
Hospital Revenue Code	301
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

Immunoglobulin E, Total LC

Facility

$196.00

Service Code	CPT 82785
Hospital Charge Code	1906908
Hospital Revenue Code	301
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of AZ Commercial	$176.40
Rate for Payer: Aetna of AZ Medicare	$54.88
Rate for Payer: Allwell Medicare	$31.36
Rate for Payer: Amerigroup Medicare	$31.36
Rate for Payer: APIPA Medicare/Medicaid	$73.21
Rate for Payer: AZCH Complete Medicare	$31.36
Rate for Payer: Banner UC Health Medicare	$31.36
Rate for Payer: Bisbee Police All Plans	$50.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$133.28
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cigna of AZ Commercial	$127.40
Rate for Payer: Copperpoint Commercial	$48.51
Rate for Payer: Health Net of AZ Commercial	$117.60
Rate for Payer: Health Net of AZ Medicare	$54.88
Rate for Payer: Humana of AZ Medicare	$31.36
Rate for Payer: Self Pay Self Pay	$156.80
Rate for Payer: TriWest Medicare	$31.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$114.27
Rate for Payer: UnitedHealth Group of AZ Medicare	$35.28

Immunoglobulin E, Total LC

Facility

$196.00

Service Code	CPT 82785
Hospital Charge Code	1906908
Hospital Revenue Code	301
Min. Negotiated Rate	$50.96
Max. Negotiated Rate	$176.40
Rate for Payer: Aetna of AZ Commercial	$176.40
Rate for Payer: Bisbee Police All Plans	$50.96
Rate for Payer: Cash Price	$156.80
Rate for Payer: Self Pay Self Pay	$156.80

Immunoglobulin G, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2029176
Hospital Revenue Code	301
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: Allwell Medicare	$18.24
Rate for Payer: Amerigroup Medicare	$18.24
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.21
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

Immunoglobulin G, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2029176
Hospital Revenue Code	301
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

Immunoglobulin M, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	1906912
Hospital Revenue Code	301
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

Immunoglobulin M, Qn, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	1906912
Hospital Revenue Code	301
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: Allwell Medicare	$18.24
Rate for Payer: Amerigroup Medicare	$18.24
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.21
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

Immunoglobulins A/E/G/M, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2087616
Hospital Revenue Code	302
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Cash Price	$91.20
Rate for Payer: Self Pay Self Pay	$91.20

Immunoglobulins A/E/G/M, Serum LC

Facility

$114.00

Service Code	CPT 82784
Hospital Charge Code	2087616
Hospital Revenue Code	302
Min. Negotiated Rate	$18.24
Max. Negotiated Rate	$102.60
Rate for Payer: Aetna of AZ Commercial	$102.60
Rate for Payer: Aetna of AZ Medicare	$31.92
Rate for Payer: Allwell Medicare	$18.24
Rate for Payer: Amerigroup Medicare	$18.24
Rate for Payer: APIPA Medicare/Medicaid	$42.58
Rate for Payer: AZCH Complete Medicare	$18.24
Rate for Payer: Banner UC Health Medicare	$18.24
Rate for Payer: Bisbee Police All Plans	$29.64
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$77.52
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cigna of AZ Commercial	$74.10
Rate for Payer: Copperpoint Commercial	$28.21
Rate for Payer: Health Net of AZ Commercial	$68.40
Rate for Payer: Health Net of AZ Medicare	$31.92
Rate for Payer: Humana of AZ Medicare	$18.24
Rate for Payer: Self Pay Self Pay	$91.20
Rate for Payer: TriWest Medicare	$18.24
Rate for Payer: UnitedHealth Group of AZ Commercial	$66.46
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.52

Immunoglobulins A/G/M, Qn, Ser LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2087617
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Self Pay Self Pay	$96.00

Immunoglobulins A/G/M, Qn, Ser LC

Facility

$120.00

Service Code	CPT 82784
Hospital Charge Code	2087617
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna of AZ Commercial	$108.00
Rate for Payer: Aetna of AZ Medicare	$33.60
Rate for Payer: Allwell Medicare	$19.20
Rate for Payer: Amerigroup Medicare	$19.20
Rate for Payer: APIPA Medicare/Medicaid	$44.82
Rate for Payer: AZCH Complete Medicare	$19.20
Rate for Payer: Banner UC Health Medicare	$19.20
Rate for Payer: Bisbee Police All Plans	$31.20
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$81.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cigna of AZ Commercial	$78.00
Rate for Payer: Copperpoint Commercial	$29.70
Rate for Payer: Health Net of AZ Commercial	$72.00
Rate for Payer: Health Net of AZ Medicare	$33.60
Rate for Payer: Humana of AZ Medicare	$19.20
Rate for Payer: Self Pay Self Pay	$96.00
Rate for Payer: TriWest Medicare	$19.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$69.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$21.60

IMMUNOHISTOCHEM ADD ANTI STAIN

Facility

$1,244.00

Service Code	CPT 88341
Hospital Charge Code	22545751
Hospital Revenue Code	310
Min. Negotiated Rate	$323.44
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Bisbee Police All Plans	$323.44
Rate for Payer: Cash Price	$995.20
Rate for Payer: Self Pay Self Pay	$995.20

IMMUNOHISTOCHEM ADD ANTI STAIN

Facility

$1,244.00

Service Code	CPT 88341
Hospital Charge Code	22545751
Hospital Revenue Code	310
Min. Negotiated Rate	$199.04
Max. Negotiated Rate	$1,119.60
Rate for Payer: Aetna of AZ Commercial	$1,119.60
Rate for Payer: Aetna of AZ Medicare	$348.32
Rate for Payer: Allwell Medicare	$199.04
Rate for Payer: Amerigroup Medicare	$199.04
Rate for Payer: APIPA Medicare/Medicaid	$464.63
Rate for Payer: AZCH Complete Medicare	$199.04
Rate for Payer: Banner UC Health Medicare	$199.04
Rate for Payer: Bisbee Police All Plans	$323.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$845.92
Rate for Payer: Cash Price	$995.20
Rate for Payer: Cigna of AZ Commercial	$808.60
Rate for Payer: Copperpoint Commercial	$307.89
Rate for Payer: Health Net of AZ Commercial	$746.40
Rate for Payer: Health Net of AZ Medicare	$348.32
Rate for Payer: Humana of AZ Medicare	$199.04
Rate for Payer: Self Pay Self Pay	$995.20
Rate for Payer: TriWest Medicare	$199.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$725.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$223.92

IMMUNOHISTOCHEMISTRY

Facility

$1,563.00

Service Code	CPT 88342
Hospital Charge Code	22545725
Hospital Revenue Code	310
Min. Negotiated Rate	$406.38
Max. Negotiated Rate	$1,406.70
Rate for Payer: Aetna of AZ Commercial	$1,406.70
Rate for Payer: Bisbee Police All Plans	$406.38
Rate for Payer: Cash Price	$1,250.40
Rate for Payer: Self Pay Self Pay	$1,250.40

IMMUNOHISTOCHEMISTRY

Facility

$1,563.00

Service Code	CPT 88342
Hospital Charge Code	22545725
Hospital Revenue Code	310
Min. Negotiated Rate	$250.08
Max. Negotiated Rate	$1,406.70
Rate for Payer: Aetna of AZ Commercial	$1,406.70
Rate for Payer: Aetna of AZ Medicare	$437.64
Rate for Payer: Allwell Medicare	$250.08
Rate for Payer: Amerigroup Medicare	$250.08
Rate for Payer: APIPA Medicare/Medicaid	$583.78
Rate for Payer: AZCH Complete Medicare	$250.08
Rate for Payer: Banner UC Health Medicare	$250.08
Rate for Payer: Bisbee Police All Plans	$406.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,062.84
Rate for Payer: Cash Price	$1,250.40
Rate for Payer: Cigna of AZ Commercial	$1,015.95
Rate for Payer: Copperpoint Commercial	$386.84
Rate for Payer: Health Net of AZ Commercial	$937.80
Rate for Payer: Health Net of AZ Medicare	$437.64
Rate for Payer: Humana of AZ Medicare	$250.08
Rate for Payer: Self Pay Self Pay	$1,250.40
Rate for Payer: TriWest Medicare	$250.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$911.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$281.34

.IMMUNO INFAB

Facility

$73.00

Service Code	CPT 86317
Hospital Charge Code	22481446
Hospital Revenue Code	302
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$65.70
Rate for Payer: Aetna of AZ Commercial	$65.70
Rate for Payer: Aetna of AZ Medicare	$20.44
Rate for Payer: Allwell Medicare	$11.68
Rate for Payer: Amerigroup Medicare	$11.68
Rate for Payer: APIPA Medicare/Medicaid	$27.27
Rate for Payer: AZCH Complete Medicare	$11.68
Rate for Payer: Banner UC Health Medicare	$11.68
Rate for Payer: Bisbee Police All Plans	$18.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$49.64
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cigna of AZ Commercial	$47.45
Rate for Payer: Copperpoint Commercial	$18.07
Rate for Payer: Health Net of AZ Commercial	$43.80
Rate for Payer: Health Net of AZ Medicare	$20.44
Rate for Payer: Humana of AZ Medicare	$11.68
Rate for Payer: Self Pay Self Pay	$58.40
Rate for Payer: TriWest Medicare	$11.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$42.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.14

Know your out-of-pocket cost for care.

All Charges