Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

82107 HEPATOCELLULAR

Facility

$226.00

Service Code	CPT 82107
Hospital Charge Code	23294379
Hospital Revenue Code	301
Min. Negotiated Rate	$58.76
Max. Negotiated Rate	$203.40
Rate for Payer: Aetna of AZ Commercial	$203.40
Rate for Payer: Bisbee Police All Plans	$58.76
Rate for Payer: Cash Price	$180.80
Rate for Payer: Self Pay Self Pay	$180.80

83735 LC#LC

Facility

$84.00

Service Code	CPT 83735
Hospital Charge Code	23173801
Hospital Revenue Code	301
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Cash Price	$67.20
Rate for Payer: Self Pay Self Pay	$67.20

83735 LC#LC

Facility

$84.00

Service Code	CPT 83735
Hospital Charge Code	23173801
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna of AZ Commercial	$75.60
Rate for Payer: Aetna of AZ Medicare	$23.52
Rate for Payer: Allwell Medicare	$13.44
Rate for Payer: Amerigroup Medicare	$13.44
Rate for Payer: APIPA Medicare/Medicaid	$31.37
Rate for Payer: AZCH Complete Medicare	$13.44
Rate for Payer: Banner UC Health Medicare	$13.44
Rate for Payer: Bisbee Police All Plans	$21.84
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$57.12
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna of AZ Commercial	$54.60
Rate for Payer: Copperpoint Commercial	$20.79
Rate for Payer: Health Net of AZ Commercial	$50.40
Rate for Payer: Health Net of AZ Medicare	$23.52
Rate for Payer: Humana of AZ Medicare	$13.44
Rate for Payer: Self Pay Self Pay	$67.20
Rate for Payer: TriWest Medicare	$13.44
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.12

83951 DCP

Facility

$318.00

Service Code	CPT 83951
Hospital Charge Code	23187087
Hospital Revenue Code	302
Min. Negotiated Rate	$82.68
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Cash Price	$254.40
Rate for Payer: Self Pay Self Pay	$254.40

83951 DCP

Facility

$318.00

Service Code	CPT 83951
Hospital Charge Code	23187087
Hospital Revenue Code	302
Min. Negotiated Rate	$50.88
Max. Negotiated Rate	$286.20
Rate for Payer: Aetna of AZ Commercial	$286.20
Rate for Payer: Aetna of AZ Medicare	$89.04
Rate for Payer: Allwell Medicare	$50.88
Rate for Payer: Amerigroup Medicare	$50.88
Rate for Payer: APIPA Medicare/Medicaid	$118.77
Rate for Payer: AZCH Complete Medicare	$50.88
Rate for Payer: Banner UC Health Medicare	$50.88
Rate for Payer: Bisbee Police All Plans	$82.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$216.24
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cigna of AZ Commercial	$206.70
Rate for Payer: Copperpoint Commercial	$78.70
Rate for Payer: Health Net of AZ Commercial	$190.80
Rate for Payer: Health Net of AZ Medicare	$89.04
Rate for Payer: Humana of AZ Medicare	$50.88
Rate for Payer: Self Pay Self Pay	$254.40
Rate for Payer: TriWest Medicare	$50.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$185.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$57.24

83992 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 83992
Hospital Charge Code	28075345
Hospital Revenue Code	301
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Aetna of AZ Medicare	$78.68
Rate for Payer: Allwell Medicare	$44.96
Rate for Payer: Amerigroup Medicare	$44.96
Rate for Payer: APIPA Medicare/Medicaid	$104.95
Rate for Payer: AZCH Complete Medicare	$44.96
Rate for Payer: Banner UC Health Medicare	$44.96
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$191.08
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cigna of AZ Commercial	$182.65
Rate for Payer: Copperpoint Commercial	$69.55
Rate for Payer: Health Net of AZ Commercial	$168.60
Rate for Payer: Health Net of AZ Medicare	$78.68
Rate for Payer: Humana of AZ Medicare	$44.96
Rate for Payer: Self Pay Self Pay	$224.80
Rate for Payer: TriWest Medicare	$44.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.58

83992 Drug Analysis Profile, Comprehensive, Ur LC

Facility

$281.00

Service Code	CPT 83992
Hospital Charge Code	28075345
Hospital Revenue Code	301
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$252.90
Rate for Payer: Aetna of AZ Commercial	$252.90
Rate for Payer: Bisbee Police All Plans	$73.06
Rate for Payer: Cash Price	$224.80
Rate for Payer: Self Pay Self Pay	$224.80

84449 Cortisol, Free, Total With CBG LC

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28059772
Hospital Revenue Code	302
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Aetna of AZ Medicare	$25.20
Rate for Payer: Allwell Medicare	$14.40
Rate for Payer: Amerigroup Medicare	$14.40
Rate for Payer: APIPA Medicare/Medicaid	$33.62
Rate for Payer: AZCH Complete Medicare	$14.40
Rate for Payer: Banner UC Health Medicare	$14.40
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of AZ Commercial	$58.50
Rate for Payer: Copperpoint Commercial	$22.27
Rate for Payer: Health Net of AZ Commercial	$54.00
Rate for Payer: Health Net of AZ Medicare	$25.20
Rate for Payer: Humana of AZ Medicare	$14.40
Rate for Payer: Self Pay Self Pay	$72.00
Rate for Payer: TriWest Medicare	$14.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$52.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.20

84449 Cortisol, Free, Total With CBG LC

Facility

$90.00

Service Code	CPT 84449
Hospital Charge Code	28059772
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna of AZ Commercial	$81.00
Rate for Payer: Bisbee Police All Plans	$23.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Self Pay Self Pay	$72.00

84702 FIRST TRIMESTER SCREEN

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	23294406
Hospital Revenue Code	301
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Cash Price	$172.00
Rate for Payer: Self Pay Self Pay	$172.00

84702 FIRST TRIMESTER SCREEN

Facility

$215.00

Service Code	CPT 84702
Hospital Charge Code	23294406
Hospital Revenue Code	301
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna of AZ Commercial	$193.50
Rate for Payer: Aetna of AZ Medicare	$60.20
Rate for Payer: Allwell Medicare	$34.40
Rate for Payer: Amerigroup Medicare	$34.40
Rate for Payer: APIPA Medicare/Medicaid	$80.30
Rate for Payer: AZCH Complete Medicare	$34.40
Rate for Payer: Banner UC Health Medicare	$34.40
Rate for Payer: Bisbee Police All Plans	$55.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$146.20
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cigna of AZ Commercial	$139.75
Rate for Payer: Copperpoint Commercial	$53.21
Rate for Payer: Health Net of AZ Commercial	$129.00
Rate for Payer: Health Net of AZ Medicare	$60.20
Rate for Payer: Humana of AZ Medicare	$34.40
Rate for Payer: Self Pay Self Pay	$172.00
Rate for Payer: TriWest Medicare	$34.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$125.34
Rate for Payer: UnitedHealth Group of AZ Medicare	$38.70

86003 Allergens(14)

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	28068400
Hospital Revenue Code	305
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

86003 Allergens(14)

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	28068400
Hospital Revenue Code	305
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

86042 AChR Ab, Complete Profile

Facility

$92.00

Service Code	CPT 86042
Hospital Charge Code	28068387
Hospital Revenue Code	305
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Cash Price	$73.60
Rate for Payer: Self Pay Self Pay	$73.60

86042 AChR Ab, Complete Profile

Facility

$92.00

Service Code	CPT 86042
Hospital Charge Code	28068387
Hospital Revenue Code	305
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna of AZ Commercial	$82.80
Rate for Payer: Aetna of AZ Medicare	$25.76
Rate for Payer: Allwell Medicare	$14.72
Rate for Payer: Amerigroup Medicare	$14.72
Rate for Payer: APIPA Medicare/Medicaid	$34.36
Rate for Payer: AZCH Complete Medicare	$14.72
Rate for Payer: Banner UC Health Medicare	$14.72
Rate for Payer: Bisbee Police All Plans	$23.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$62.56
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cigna of AZ Commercial	$59.80
Rate for Payer: Copperpoint Commercial	$22.77
Rate for Payer: Health Net of AZ Commercial	$55.20
Rate for Payer: Health Net of AZ Medicare	$25.76
Rate for Payer: Humana of AZ Medicare	$14.72
Rate for Payer: Self Pay Self Pay	$73.60
Rate for Payer: TriWest Medicare	$14.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.64
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.56

86043 AChR Ab, Complete Profile

Facility

$60.00

Service Code	CPT 86043
Hospital Charge Code	28070397
Hospital Revenue Code	305
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Self Pay Self Pay	$48.00

86043 AChR Ab, Complete Profile

Facility

$60.00

Service Code	CPT 86043
Hospital Charge Code	28070397
Hospital Revenue Code	305
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna of AZ Commercial	$54.00
Rate for Payer: Aetna of AZ Medicare	$16.80
Rate for Payer: Allwell Medicare	$9.60
Rate for Payer: Amerigroup Medicare	$9.60
Rate for Payer: APIPA Medicare/Medicaid	$22.41
Rate for Payer: AZCH Complete Medicare	$9.60
Rate for Payer: Banner UC Health Medicare	$9.60
Rate for Payer: Bisbee Police All Plans	$15.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$40.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cigna of AZ Commercial	$39.00
Rate for Payer: Copperpoint Commercial	$14.85
Rate for Payer: Health Net of AZ Commercial	$36.00
Rate for Payer: Health Net of AZ Medicare	$16.80
Rate for Payer: Humana of AZ Medicare	$9.60
Rate for Payer: Self Pay Self Pay	$48.00
Rate for Payer: TriWest Medicare	$9.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$34.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$10.80

86331 HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$151.00

Service Code	CPT 86331
Hospital Charge Code	23298045
Hospital Revenue Code	301
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Aetna of AZ Medicare	$42.28
Rate for Payer: Allwell Medicare	$24.16
Rate for Payer: Amerigroup Medicare	$24.16
Rate for Payer: APIPA Medicare/Medicaid	$56.40
Rate for Payer: AZCH Complete Medicare	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$102.68
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Copperpoint Commercial	$37.37
Rate for Payer: Health Net of AZ Commercial	$90.60
Rate for Payer: Health Net of AZ Medicare	$42.28
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Self Pay Self Pay	$120.80
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.18

86331 HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$94.00

Service Code	CPT 86671
Hospital Charge Code	23298039
Hospital Revenue Code	301
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Bisbee Police All Plans	$24.44
Rate for Payer: Cash Price	$75.20
Rate for Payer: Self Pay Self Pay	$75.20

86331 HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$94.00

Service Code	CPT 86671
Hospital Charge Code	23298039
Hospital Revenue Code	301
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna of AZ Commercial	$84.60
Rate for Payer: Aetna of AZ Medicare	$26.32
Rate for Payer: Allwell Medicare	$15.04
Rate for Payer: Amerigroup Medicare	$15.04
Rate for Payer: APIPA Medicare/Medicaid	$35.11
Rate for Payer: AZCH Complete Medicare	$15.04
Rate for Payer: Banner UC Health Medicare	$15.04
Rate for Payer: Bisbee Police All Plans	$24.44
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$63.92
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cigna of AZ Commercial	$61.10
Rate for Payer: Copperpoint Commercial	$23.27
Rate for Payer: Health Net of AZ Commercial	$56.40
Rate for Payer: Health Net of AZ Medicare	$26.32
Rate for Payer: Humana of AZ Medicare	$15.04
Rate for Payer: Self Pay Self Pay	$75.20
Rate for Payer: TriWest Medicare	$15.04
Rate for Payer: UnitedHealth Group of AZ Commercial	$54.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.92

86331 HYPERSENSITIVITY PNEUMONITIS PANEL

Facility

$151.00

Service Code	CPT 86331
Hospital Charge Code	23298045
Hospital Revenue Code	301
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Cash Price	$120.80
Rate for Payer: Self Pay Self Pay	$120.80

86356 MONONUCLEAR CELL ANTIGEN

Facility

$138.00

Service Code	CPT 86356
Hospital Charge Code	23568452
Hospital Revenue Code	301
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Aetna of AZ Medicare	$38.64
Rate for Payer: Allwell Medicare	$22.08
Rate for Payer: Amerigroup Medicare	$22.08
Rate for Payer: APIPA Medicare/Medicaid	$51.54
Rate for Payer: AZCH Complete Medicare	$22.08
Rate for Payer: Banner UC Health Medicare	$22.08
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$93.84
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cigna of AZ Commercial	$89.70
Rate for Payer: Copperpoint Commercial	$34.16
Rate for Payer: Health Net of AZ Commercial	$82.80
Rate for Payer: Health Net of AZ Medicare	$38.64
Rate for Payer: Humana of AZ Medicare	$22.08
Rate for Payer: Self Pay Self Pay	$110.40
Rate for Payer: TriWest Medicare	$22.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$80.45
Rate for Payer: UnitedHealth Group of AZ Medicare	$24.84

86356 MONONUCLEAR CELL ANTIGEN

Facility

$138.00

Service Code	CPT 86356
Hospital Charge Code	23568452
Hospital Revenue Code	301
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$124.20
Rate for Payer: Aetna of AZ Commercial	$124.20
Rate for Payer: Bisbee Police All Plans	$35.88
Rate for Payer: Cash Price	$110.40
Rate for Payer: Self Pay Self Pay	$110.40

86357 NATURAL KILLER CELL SURFACE AG

Facility

$363.00

Service Code	CPT 86357
Hospital Charge Code	23568453
Hospital Revenue Code	301
Min. Negotiated Rate	$94.38
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Cash Price	$290.40
Rate for Payer: Self Pay Self Pay	$290.40

86357 NATURAL KILLER CELL SURFACE AG

Facility

$363.00

Service Code	CPT 86357
Hospital Charge Code	23568453
Hospital Revenue Code	301
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$326.70
Rate for Payer: Aetna of AZ Commercial	$326.70
Rate for Payer: Aetna of AZ Medicare	$101.64
Rate for Payer: Allwell Medicare	$58.08
Rate for Payer: Amerigroup Medicare	$58.08
Rate for Payer: APIPA Medicare/Medicaid	$135.58
Rate for Payer: AZCH Complete Medicare	$58.08
Rate for Payer: Banner UC Health Medicare	$58.08
Rate for Payer: Bisbee Police All Plans	$94.38
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$246.84
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cigna of AZ Commercial	$235.95
Rate for Payer: Copperpoint Commercial	$89.84
Rate for Payer: Health Net of AZ Commercial	$217.80
Rate for Payer: Health Net of AZ Medicare	$101.64
Rate for Payer: Humana of AZ Medicare	$58.08
Rate for Payer: Self Pay Self Pay	$290.40
Rate for Payer: TriWest Medicare	$58.08
Rate for Payer: UnitedHealth Group of AZ Commercial	$211.63
Rate for Payer: UnitedHealth Group of AZ Medicare	$65.34

Know your out-of-pocket cost for care.

All Charges