Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

86359 T LYMPH CD3 CELLS

Facility

$331.00

Service Code	CPT 86359
Hospital Charge Code	23568454
Hospital Revenue Code	301
Min. Negotiated Rate	$52.96
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Aetna of AZ Medicare	$92.68
Rate for Payer: Allwell Medicare	$52.96
Rate for Payer: Amerigroup Medicare	$52.96
Rate for Payer: APIPA Medicare/Medicaid	$123.63
Rate for Payer: AZCH Complete Medicare	$52.96
Rate for Payer: Banner UC Health Medicare	$52.96
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$225.08
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cigna of AZ Commercial	$215.15
Rate for Payer: Copperpoint Commercial	$81.92
Rate for Payer: Health Net of AZ Commercial	$198.60
Rate for Payer: Health Net of AZ Medicare	$92.68
Rate for Payer: Humana of AZ Medicare	$52.96
Rate for Payer: Self Pay Self Pay	$264.80
Rate for Payer: TriWest Medicare	$52.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$192.97
Rate for Payer: UnitedHealth Group of AZ Medicare	$59.58

86359 T LYMPH CD3 CELLS

Facility

$331.00

Service Code	CPT 86359
Hospital Charge Code	23568454
Hospital Revenue Code	301
Min. Negotiated Rate	$86.06
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna of AZ Commercial	$297.90
Rate for Payer: Bisbee Police All Plans	$86.06
Rate for Payer: Cash Price	$264.80
Rate for Payer: Self Pay Self Pay	$264.80

86628 CANDIDA AB

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	23294423
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Aetna of AZ Medicare	$71.40
Rate for Payer: Allwell Medicare	$40.80
Rate for Payer: Amerigroup Medicare	$40.80
Rate for Payer: APIPA Medicare/Medicaid	$95.24
Rate for Payer: AZCH Complete Medicare	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$173.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Copperpoint Commercial	$63.11
Rate for Payer: Health Net of AZ Commercial	$153.00
Rate for Payer: Health Net of AZ Medicare	$71.40
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Self Pay Self Pay	$204.00
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.90

86628 CANDIDA AB

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	23294423
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Cash Price	$204.00
Rate for Payer: Self Pay Self Pay	$204.00

86628 LC#LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	23173802
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Aetna of AZ Medicare	$71.40
Rate for Payer: Allwell Medicare	$40.80
Rate for Payer: Amerigroup Medicare	$40.80
Rate for Payer: APIPA Medicare/Medicaid	$95.24
Rate for Payer: AZCH Complete Medicare	$40.80
Rate for Payer: Banner UC Health Medicare	$40.80
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$173.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cigna of AZ Commercial	$165.75
Rate for Payer: Copperpoint Commercial	$63.11
Rate for Payer: Health Net of AZ Commercial	$153.00
Rate for Payer: Health Net of AZ Medicare	$71.40
Rate for Payer: Humana of AZ Medicare	$40.80
Rate for Payer: Self Pay Self Pay	$204.00
Rate for Payer: TriWest Medicare	$40.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$148.66
Rate for Payer: UnitedHealth Group of AZ Medicare	$45.90

86628 LC#LC

Facility

$255.00

Service Code	CPT 86628
Hospital Charge Code	23173802
Hospital Revenue Code	302
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna of AZ Commercial	$229.50
Rate for Payer: Bisbee Police All Plans	$66.30
Rate for Payer: Cash Price	$204.00
Rate for Payer: Self Pay Self Pay	$204.00

87328 Giardia lamblia

Facility

$258.00

Service Code	CPT 87328
Hospital Charge Code	23173791
Hospital Revenue Code	302
Min. Negotiated Rate	$67.08
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Cash Price	$206.40
Rate for Payer: Self Pay Self Pay	$206.40

87328 Giardia lamblia

Facility

$258.00

Service Code	CPT 87328
Hospital Charge Code	23173791
Hospital Revenue Code	302
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$232.20
Rate for Payer: Aetna of AZ Commercial	$232.20
Rate for Payer: Aetna of AZ Medicare	$72.24
Rate for Payer: Allwell Medicare	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: APIPA Medicare/Medicaid	$96.36
Rate for Payer: AZCH Complete Medicare	$41.28
Rate for Payer: Banner UC Health Medicare	$41.28
Rate for Payer: Bisbee Police All Plans	$67.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$175.44
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cigna of AZ Commercial	$167.70
Rate for Payer: Copperpoint Commercial	$63.85
Rate for Payer: Health Net of AZ Commercial	$154.80
Rate for Payer: Health Net of AZ Medicare	$72.24
Rate for Payer: Humana of AZ Medicare	$41.28
Rate for Payer: Self Pay Self Pay	$206.40
Rate for Payer: TriWest Medicare	$41.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$150.41
Rate for Payer: UnitedHealth Group of AZ Medicare	$46.44

87328 Giardia Lamblia

Facility

$272.00

Service Code	CPT 87328
Hospital Charge Code	23309228
Hospital Revenue Code	300
Min. Negotiated Rate	$43.52
Max. Negotiated Rate	$244.80
Rate for Payer: Aetna of AZ Commercial	$244.80
Rate for Payer: Aetna of AZ Medicare	$76.16
Rate for Payer: Allwell Medicare	$43.52
Rate for Payer: Amerigroup Medicare	$43.52
Rate for Payer: APIPA Medicare/Medicaid	$101.59
Rate for Payer: AZCH Complete Medicare	$43.52
Rate for Payer: Banner UC Health Medicare	$43.52
Rate for Payer: Bisbee Police All Plans	$70.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$184.96
Rate for Payer: Cash Price	$217.60
Rate for Payer: Cigna of AZ Commercial	$176.80
Rate for Payer: Copperpoint Commercial	$67.32
Rate for Payer: Health Net of AZ Commercial	$163.20
Rate for Payer: Health Net of AZ Medicare	$76.16
Rate for Payer: Humana of AZ Medicare	$43.52
Rate for Payer: Self Pay Self Pay	$217.60
Rate for Payer: TriWest Medicare	$43.52
Rate for Payer: UnitedHealth Group of AZ Commercial	$158.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$48.96

87328 Giardia Lamblia

Facility

$272.00

Service Code	CPT 87328
Hospital Charge Code	23309228
Hospital Revenue Code	300
Min. Negotiated Rate	$70.72
Max. Negotiated Rate	$244.80
Rate for Payer: Aetna of AZ Commercial	$244.80
Rate for Payer: Bisbee Police All Plans	$70.72
Rate for Payer: Cash Price	$217.60
Rate for Payer: Self Pay Self Pay	$217.60

87329 Giardia lamblia

Facility

$228.00

Service Code	CPT 87329
Hospital Charge Code	23173792
Hospital Revenue Code	302
Min. Negotiated Rate	$59.28
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Cash Price	$182.40
Rate for Payer: Self Pay Self Pay	$182.40

87329 Giardia lamblia

Facility

$228.00

Service Code	CPT 87329
Hospital Charge Code	23173792
Hospital Revenue Code	302
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna of AZ Commercial	$205.20
Rate for Payer: Aetna of AZ Medicare	$63.84
Rate for Payer: Allwell Medicare	$36.48
Rate for Payer: Amerigroup Medicare	$36.48
Rate for Payer: APIPA Medicare/Medicaid	$85.16
Rate for Payer: AZCH Complete Medicare	$36.48
Rate for Payer: Banner UC Health Medicare	$36.48
Rate for Payer: Bisbee Police All Plans	$59.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$155.04
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cigna of AZ Commercial	$148.20
Rate for Payer: Copperpoint Commercial	$56.43
Rate for Payer: Health Net of AZ Commercial	$136.80
Rate for Payer: Health Net of AZ Medicare	$63.84
Rate for Payer: Humana of AZ Medicare	$36.48
Rate for Payer: Self Pay Self Pay	$182.40
Rate for Payer: TriWest Medicare	$36.48
Rate for Payer: UnitedHealth Group of AZ Commercial	$132.92
Rate for Payer: UnitedHealth Group of AZ Medicare	$41.04

87798 Acute Measles Panel, IgM Antibody and PCR LC

Facility

$76.00

Service Code	CPT 87798
Hospital Charge Code	28061914
Hospital Revenue Code	302
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Cash Price	$60.80
Rate for Payer: Self Pay Self Pay	$60.80

87798 Acute Measles Panel, IgM Antibody and PCR LC

Facility

$76.00

Service Code	CPT 87798
Hospital Charge Code	28061914
Hospital Revenue Code	302
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$68.40
Rate for Payer: Aetna of AZ Commercial	$68.40
Rate for Payer: Aetna of AZ Medicare	$21.28
Rate for Payer: Allwell Medicare	$12.16
Rate for Payer: Amerigroup Medicare	$12.16
Rate for Payer: APIPA Medicare/Medicaid	$28.39
Rate for Payer: AZCH Complete Medicare	$12.16
Rate for Payer: Banner UC Health Medicare	$12.16
Rate for Payer: Bisbee Police All Plans	$19.76
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$51.68
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cigna of AZ Commercial	$49.40
Rate for Payer: Copperpoint Commercial	$18.81
Rate for Payer: Health Net of AZ Commercial	$45.60
Rate for Payer: Health Net of AZ Medicare	$21.28
Rate for Payer: Humana of AZ Medicare	$12.16
Rate for Payer: Self Pay Self Pay	$60.80
Rate for Payer: TriWest Medicare	$12.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$44.31
Rate for Payer: UnitedHealth Group of AZ Medicare	$13.68

87900 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$259.74
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Cash Price	$799.20
Rate for Payer: Self Pay Self Pay	$799.20

87900 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Aetna of AZ Medicare	$279.72
Rate for Payer: Allwell Medicare	$159.84
Rate for Payer: Amerigroup Medicare	$159.84
Rate for Payer: APIPA Medicare/Medicaid	$373.13
Rate for Payer: AZCH Complete Medicare	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$679.32
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Copperpoint Commercial	$247.25
Rate for Payer: Health Net of AZ Commercial	$599.40
Rate for Payer: Health Net of AZ Medicare	$279.72
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Self Pay Self Pay	$799.20
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$582.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$179.82

87900 HIV-1 Quant PCR

Facility

$999.00

Service Code	CPT 87900
Hospital Charge Code	23173798
Hospital Revenue Code	306
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Aetna of AZ Medicare	$279.72
Rate for Payer: Allwell Medicare	$159.84
Rate for Payer: Amerigroup Medicare	$159.84
Rate for Payer: APIPA Medicare/Medicaid	$373.13
Rate for Payer: AZCH Complete Medicare	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$679.32
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Copperpoint Commercial	$247.25
Rate for Payer: Health Net of AZ Commercial	$599.40
Rate for Payer: Health Net of AZ Medicare	$279.72
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Self Pay Self Pay	$799.20
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$582.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$179.82

87900 HIV-1 Quant PCR

Facility

$999.00

Service Code	CPT 87900
Hospital Charge Code	23173798
Hospital Revenue Code	306
Min. Negotiated Rate	$259.74
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Cash Price	$799.20
Rate for Payer: Self Pay Self Pay	$799.20

87901 HIV-1 Quant PCR

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173796
Hospital Revenue Code	306
Min. Negotiated Rate	$240.32
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Aetna of AZ Medicare	$420.56
Rate for Payer: Allwell Medicare	$240.32
Rate for Payer: Amerigroup Medicare	$240.32
Rate for Payer: APIPA Medicare/Medicaid	$561.00
Rate for Payer: AZCH Complete Medicare	$240.32
Rate for Payer: Banner UC Health Medicare	$240.32
Rate for Payer: Bisbee Police All Plans	$390.52
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,021.36
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Cigna of AZ Commercial	$976.30
Rate for Payer: Copperpoint Commercial	$371.75
Rate for Payer: Health Net of AZ Commercial	$901.20
Rate for Payer: Health Net of AZ Medicare	$420.56
Rate for Payer: Humana of AZ Medicare	$240.32
Rate for Payer: Self Pay Self Pay	$1,201.60
Rate for Payer: TriWest Medicare	$240.32
Rate for Payer: UnitedHealth Group of AZ Commercial	$875.67
Rate for Payer: UnitedHealth Group of AZ Medicare	$270.36

87901 HIV-1 Quant PCR

Facility

$1,502.00

Service Code	CPT 87901
Hospital Charge Code	23173796
Hospital Revenue Code	306
Min. Negotiated Rate	$390.52
Max. Negotiated Rate	$1,351.80
Rate for Payer: Aetna of AZ Commercial	$1,351.80
Rate for Payer: Bisbee Police All Plans	$390.52
Rate for Payer: Cash Price	$1,201.60
Rate for Payer: Self Pay Self Pay	$1,201.60

87906 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$259.74
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Cash Price	$799.20
Rate for Payer: Self Pay Self Pay	$799.20

87906 HIV-1 Genosure Archive

Facility

$999.00

Service Code	CPT 87901
Hospital Charge Code	23173795
Hospital Revenue Code	306
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$899.10
Rate for Payer: Aetna of AZ Commercial	$899.10
Rate for Payer: Aetna of AZ Medicare	$279.72
Rate for Payer: Allwell Medicare	$159.84
Rate for Payer: Amerigroup Medicare	$159.84
Rate for Payer: APIPA Medicare/Medicaid	$373.13
Rate for Payer: AZCH Complete Medicare	$159.84
Rate for Payer: Banner UC Health Medicare	$159.84
Rate for Payer: Bisbee Police All Plans	$259.74
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$679.32
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cigna of AZ Commercial	$649.35
Rate for Payer: Copperpoint Commercial	$247.25
Rate for Payer: Health Net of AZ Commercial	$599.40
Rate for Payer: Health Net of AZ Medicare	$279.72
Rate for Payer: Humana of AZ Medicare	$159.84
Rate for Payer: Self Pay Self Pay	$799.20
Rate for Payer: TriWest Medicare	$159.84
Rate for Payer: UnitedHealth Group of AZ Commercial	$582.42
Rate for Payer: UnitedHealth Group of AZ Medicare	$179.82

87906 HIV-1 Genosure Archive

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173794
Hospital Revenue Code	301
Min. Negotiated Rate	$143.26
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Cash Price	$440.80
Rate for Payer: Self Pay Self Pay	$440.80

87906 HIV-1 Genosure Archive

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173794
Hospital Revenue Code	301
Min. Negotiated Rate	$88.16
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Aetna of AZ Medicare	$154.28
Rate for Payer: Allwell Medicare	$88.16
Rate for Payer: Amerigroup Medicare	$88.16
Rate for Payer: APIPA Medicare/Medicaid	$205.80
Rate for Payer: AZCH Complete Medicare	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.68
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Copperpoint Commercial	$136.37
Rate for Payer: Health Net of AZ Commercial	$330.60
Rate for Payer: Health Net of AZ Medicare	$154.28
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Self Pay Self Pay	$440.80
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$321.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.18

87906 HIV-1 Quant PCR

Facility

$551.00

Service Code	CPT 87906
Hospital Charge Code	23173797
Hospital Revenue Code	301
Min. Negotiated Rate	$88.16
Max. Negotiated Rate	$495.90
Rate for Payer: Aetna of AZ Commercial	$495.90
Rate for Payer: Aetna of AZ Medicare	$154.28
Rate for Payer: Allwell Medicare	$88.16
Rate for Payer: Amerigroup Medicare	$88.16
Rate for Payer: APIPA Medicare/Medicaid	$205.80
Rate for Payer: AZCH Complete Medicare	$88.16
Rate for Payer: Banner UC Health Medicare	$88.16
Rate for Payer: Bisbee Police All Plans	$143.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$374.68
Rate for Payer: Cash Price	$440.80
Rate for Payer: Cigna of AZ Commercial	$358.15
Rate for Payer: Copperpoint Commercial	$136.37
Rate for Payer: Health Net of AZ Commercial	$330.60
Rate for Payer: Health Net of AZ Medicare	$154.28
Rate for Payer: Humana of AZ Medicare	$88.16
Rate for Payer: Self Pay Self Pay	$440.80
Rate for Payer: TriWest Medicare	$88.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$321.23
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.18

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