Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

acetaminophen 325 mg Tab [CQCH]

Facility

$0.01

Service Code	NDC 50580060002
Hospital Charge Code	105907813
Hospital Revenue Code	257
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna of AZ Commercial	$0.01
Rate for Payer: Aetna of AZ Medicare	$0.00
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.00
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.00
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.01
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

acetaminophen 500 mg Tab [CQCH]

Facility

$0.02

Service Code	NDC 50580041202
Hospital Charge Code	105907746
Hospital Revenue Code	257
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Aetna of AZ Medicare	$0.01
Rate for Payer: Allwell Medicare	$0.00
Rate for Payer: Amerigroup Medicare	$0.00
Rate for Payer: APIPA Medicare/Medicaid	$0.01
Rate for Payer: AZCH Complete Medicare	$0.00
Rate for Payer: Banner UC Health Medicare	$0.00
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of AZ Commercial	$0.01
Rate for Payer: Copperpoint Commercial	$0.00
Rate for Payer: Health Net of AZ Commercial	$0.01
Rate for Payer: Health Net of AZ Medicare	$0.01
Rate for Payer: Humana of AZ Medicare	$0.00
Rate for Payer: Self Pay Self Pay	$0.02
Rate for Payer: TriWest Medicare	$0.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.00

acetaminophen 500 mg Tab [CQCH]

Facility

$0.02

Service Code	NDC 50580041202
Hospital Charge Code	105907746
Hospital Revenue Code	257
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of AZ Commercial	$0.02
Rate for Payer: Bisbee Police All Plans	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Self Pay Self Pay	$0.02

acetaminophen 650 mg Supp [CQCH]

Facility

$0.42

Service Code	NDC 713016512
Hospital Charge Code	105907681
Hospital Revenue Code	257
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Cash Price	$0.34
Rate for Payer: Self Pay Self Pay	$0.34

acetaminophen 650 mg Supp [CQCH]

Facility

$0.42

Service Code	NDC 713016512
Hospital Charge Code	105907681
Hospital Revenue Code	257
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.38
Rate for Payer: Aetna of AZ Commercial	$0.38
Rate for Payer: Aetna of AZ Medicare	$0.12
Rate for Payer: Allwell Medicare	$0.06
Rate for Payer: Amerigroup Medicare	$0.06
Rate for Payer: APIPA Medicare/Medicaid	$0.16
Rate for Payer: AZCH Complete Medicare	$0.06
Rate for Payer: Banner UC Health Medicare	$0.06
Rate for Payer: Bisbee Police All Plans	$0.11
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.29
Rate for Payer: Cash Price	$0.34
Rate for Payer: Cigna of AZ Commercial	$0.27
Rate for Payer: Copperpoint Commercial	$0.10
Rate for Payer: Health Net of AZ Commercial	$0.25
Rate for Payer: Health Net of AZ Medicare	$0.12
Rate for Payer: Humana of AZ Medicare	$0.06
Rate for Payer: Self Pay Self Pay	$0.34
Rate for Payer: TriWest Medicare	$0.06
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Cash Price	$0.79
Rate for Payer: Self Pay Self Pay	$0.79

acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg Tab [CQCH]

Facility

$0.99

Service Code	NDC 68084039665
Hospital Charge Code	105908090
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.89
Rate for Payer: Aetna of AZ Commercial	$0.89
Rate for Payer: Aetna of AZ Medicare	$0.28
Rate for Payer: Allwell Medicare	$0.15
Rate for Payer: Amerigroup Medicare	$0.15
Rate for Payer: APIPA Medicare/Medicaid	$0.37
Rate for Payer: AZCH Complete Medicare	$0.15
Rate for Payer: Banner UC Health Medicare	$0.15
Rate for Payer: Bisbee Police All Plans	$0.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.67
Rate for Payer: Cash Price	$0.79
Rate for Payer: Cigna of AZ Commercial	$0.64
Rate for Payer: Copperpoint Commercial	$0.25
Rate for Payer: Health Net of AZ Commercial	$0.59
Rate for Payer: Health Net of AZ Medicare	$0.28
Rate for Payer: Humana of AZ Medicare	$0.15
Rate for Payer: Self Pay Self Pay	$0.79
Rate for Payer: TriWest Medicare	$0.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.58
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.18

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Cash Price	$0.27
Rate for Payer: Self Pay Self Pay	$0.26

acetaminophen-HYDROcodone 325 mg-5 mg Tab [CQCH]

Facility

$0.33

Service Code	NDC 406012362
Hospital Charge Code	105908680
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.30
Rate for Payer: Aetna of AZ Commercial	$0.30
Rate for Payer: Aetna of AZ Medicare	$0.09
Rate for Payer: Allwell Medicare	$0.05
Rate for Payer: Amerigroup Medicare	$0.05
Rate for Payer: APIPA Medicare/Medicaid	$0.12
Rate for Payer: AZCH Complete Medicare	$0.05
Rate for Payer: Banner UC Health Medicare	$0.05
Rate for Payer: Bisbee Police All Plans	$0.09
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.22
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of AZ Commercial	$0.21
Rate for Payer: Copperpoint Commercial	$0.08
Rate for Payer: Health Net of AZ Commercial	$0.20
Rate for Payer: Health Net of AZ Medicare	$0.09
Rate for Payer: Humana of AZ Medicare	$0.05
Rate for Payer: Self Pay Self Pay	$0.26
Rate for Payer: TriWest Medicare	$0.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.06

Acetaminophen Level

Facility

$301.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$78.26
Max. Negotiated Rate	$270.90
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Bisbee Police All Plans	$78.26
Rate for Payer: Cash Price	$240.80
Rate for Payer: Self Pay Self Pay	$240.80

Acetaminophen Level

Facility

$301.00

Service Code	CPT 80329
Hospital Charge Code	857776
Hospital Revenue Code	301
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$270.90
Rate for Payer: Aetna of AZ Commercial	$270.90
Rate for Payer: Aetna of AZ Medicare	$84.28
Rate for Payer: AHCCCS Medicaid	$0.13
Rate for Payer: Allwell Medicaid	$0.13
Rate for Payer: Allwell Medicare	$45.15
Rate for Payer: Amerigroup Medicare	$45.15
Rate for Payer: APIPA Medicare/Medicaid	$112.42
Rate for Payer: AZCH Complete Medicaid	$0.13
Rate for Payer: AZCH Complete Medicare	$45.15
Rate for Payer: Banner UC Health Medicaid	$0.13
Rate for Payer: Banner UC Health Medicare	$45.15
Rate for Payer: Bisbee Police All Plans	$78.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$204.68
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cigna of AZ Commercial	$195.65
Rate for Payer: Copperpoint Commercial	$74.50
Rate for Payer: Health Net of AZ Commercial	$180.60
Rate for Payer: Health Net of AZ Medicare	$84.28
Rate for Payer: Humana of AZ Medicare	$45.15
Rate for Payer: Mercy Care Medicaid	$0.13
Rate for Payer: Self Pay Self Pay	$240.80
Rate for Payer: TriWest Medicare	$45.15
Rate for Payer: UnitedHealth Group of AZ Commercial	$175.48
Rate for Payer: UnitedHealth Group of AZ Medicare	$54.18

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Cash Price	$0.17
Rate for Payer: Self Pay Self Pay	$0.18

acetaminophen-oxyCODONE 325 mg-5 mg Tab [CQCH]

Facility

$0.22

Service Code	NDC 406051262
Hospital Charge Code	105908747
Hospital Revenue Code	251
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of AZ Commercial	$0.20
Rate for Payer: Aetna of AZ Medicare	$0.06
Rate for Payer: Allwell Medicare	$0.03
Rate for Payer: Amerigroup Medicare	$0.03
Rate for Payer: APIPA Medicare/Medicaid	$0.08
Rate for Payer: AZCH Complete Medicare	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Bisbee Police All Plans	$0.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.15
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of AZ Commercial	$0.14
Rate for Payer: Copperpoint Commercial	$0.05
Rate for Payer: Health Net of AZ Commercial	$0.13
Rate for Payer: Health Net of AZ Medicare	$0.06
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Self Pay Self Pay	$0.18
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.13
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.04

Acetone Ql

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Aetna of AZ Medicare	$44.52
Rate for Payer: AHCCCS Medicaid	$9.46
Rate for Payer: Allwell Medicaid	$9.46
Rate for Payer: Allwell Medicare	$23.85
Rate for Payer: Amerigroup Medicare	$23.85
Rate for Payer: APIPA Medicare/Medicaid	$59.39
Rate for Payer: AZCH Complete Medicaid	$9.46
Rate for Payer: AZCH Complete Medicare	$23.85
Rate for Payer: Banner UC Health Medicaid	$9.46
Rate for Payer: Banner UC Health Medicare	$23.85
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$108.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cigna of AZ Commercial	$103.35
Rate for Payer: Copperpoint Commercial	$39.35
Rate for Payer: Health Net of AZ Commercial	$95.40
Rate for Payer: Health Net of AZ Medicare	$44.52
Rate for Payer: Humana of AZ Medicare	$23.85
Rate for Payer: Mercy Care Medicaid	$9.46
Rate for Payer: Self Pay Self Pay	$127.20
Rate for Payer: TriWest Medicare	$23.85
Rate for Payer: UnitedHealth Group of AZ Commercial	$92.70
Rate for Payer: UnitedHealth Group of AZ Medicare	$28.62

Acetone Ql

Facility

$159.00

Service Code	CPT 82575
Hospital Charge Code	857781
Hospital Revenue Code	301
Min. Negotiated Rate	$41.34
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna of AZ Commercial	$143.10
Rate for Payer: Bisbee Police All Plans	$41.34
Rate for Payer: Cash Price	$127.20
Rate for Payer: Self Pay Self Pay	$127.20

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$137.28
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Cash Price	$422.40
Rate for Payer: Self Pay Self Pay	$422.40

Acetylcholine Receptor Ab, All LC

Facility

$528.00

Service Code	CPT 83519
Hospital Charge Code	10864412
Hospital Revenue Code	300
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$475.20
Rate for Payer: Aetna of AZ Commercial	$475.20
Rate for Payer: Aetna of AZ Medicare	$147.84
Rate for Payer: AHCCCS Medicaid	$18.40
Rate for Payer: Allwell Medicaid	$18.40
Rate for Payer: Allwell Medicare	$79.20
Rate for Payer: Amerigroup Medicare	$79.20
Rate for Payer: APIPA Medicare/Medicaid	$197.21
Rate for Payer: AZCH Complete Medicaid	$18.40
Rate for Payer: AZCH Complete Medicare	$79.20
Rate for Payer: Banner UC Health Medicaid	$18.40
Rate for Payer: Banner UC Health Medicare	$79.20
Rate for Payer: Bisbee Police All Plans	$137.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$359.04
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cigna of AZ Commercial	$343.20
Rate for Payer: Copperpoint Commercial	$130.68
Rate for Payer: Health Net of AZ Commercial	$316.80
Rate for Payer: Health Net of AZ Medicare	$147.84
Rate for Payer: Humana of AZ Medicare	$79.20
Rate for Payer: Mercy Care Medicaid	$18.40
Rate for Payer: Self Pay Self Pay	$422.40
Rate for Payer: TriWest Medicare	$79.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$307.82
Rate for Payer: UnitedHealth Group of AZ Medicare	$95.04

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Aetna of AZ Medicare	$0.27
Rate for Payer: AHCCCS Medicaid	$0.08
Rate for Payer: Allwell Medicaid	$0.08
Rate for Payer: Allwell Medicare	$0.14
Rate for Payer: Amerigroup Medicare	$0.14
Rate for Payer: APIPA Medicare/Medicaid	$0.36
Rate for Payer: AZCH Complete Medicaid	$0.08
Rate for Payer: AZCH Complete Medicare	$0.14
Rate for Payer: Banner UC Health Medicaid	$0.08
Rate for Payer: Banner UC Health Medicare	$0.14
Rate for Payer: Bisbee Police All Plans	$0.25
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.65
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cash Price	$0.77
Rate for Payer: Cigna of AZ Commercial	$0.62
Rate for Payer: Copperpoint Commercial	$0.24
Rate for Payer: Health Net of AZ Commercial	$0.58
Rate for Payer: Health Net of AZ Medicare	$0.27
Rate for Payer: Humana of AZ Medicare	$0.14
Rate for Payer: Mercy Care Medicaid	$0.08
Rate for Payer: Self Pay Self Pay	$0.77
Rate for Payer: TriWest Medicare	$0.14
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.17

acetylcysteine 20% Inh Sol 4 mL [CQCH]

Facility

$0.96

Service Code	HCPCS J7604
Hospital Charge Code	105909114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of AZ Commercial	$0.86
Rate for Payer: Bisbee Police All Plans	$0.25
Rate for Payer: Cash Price	$0.77
Rate for Payer: Self Pay Self Pay	$0.77

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.36
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Cash Price	$1.21
Rate for Payer: Self Pay Self Pay	$1.21

acetylcysteine 6 gm/ 30 mL IV Sol [CQCH]

Facility

$1.51

Service Code	HCPCS J0132
Hospital Charge Code	105909039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of AZ Commercial	$1.36
Rate for Payer: Aetna of AZ Medicare	$0.42
Rate for Payer: AHCCCS Medicaid	$1.88
Rate for Payer: Allwell Medicaid	$1.88
Rate for Payer: Allwell Medicare	$0.23
Rate for Payer: Amerigroup Medicare	$0.23
Rate for Payer: APIPA Medicare/Medicaid	$0.56
Rate for Payer: AZCH Complete Medicaid	$1.88
Rate for Payer: AZCH Complete Medicare	$0.23
Rate for Payer: Banner UC Health Medicaid	$1.88
Rate for Payer: Banner UC Health Medicare	$0.23
Rate for Payer: Bisbee Police All Plans	$0.39
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.03
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cash Price	$1.21
Rate for Payer: Cigna of AZ Commercial	$0.98
Rate for Payer: Copperpoint Commercial	$0.37
Rate for Payer: Health Net of AZ Commercial	$0.91
Rate for Payer: Health Net of AZ Medicare	$0.42
Rate for Payer: Humana of AZ Medicare	$0.23
Rate for Payer: Mercy Care Medicaid	$1.88
Rate for Payer: Self Pay Self Pay	$1.21
Rate for Payer: TriWest Medicare	$0.23
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.88
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.27

AChR Binding Abs LC

Facility

$554.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Aetna of AZ Medicare	$155.12
Rate for Payer: AHCCCS Medicaid	$18.40
Rate for Payer: Allwell Medicaid	$18.40
Rate for Payer: Allwell Medicare	$83.10
Rate for Payer: Amerigroup Medicare	$83.10
Rate for Payer: APIPA Medicare/Medicaid	$206.92
Rate for Payer: AZCH Complete Medicaid	$18.40
Rate for Payer: AZCH Complete Medicare	$83.10
Rate for Payer: Banner UC Health Medicaid	$18.40
Rate for Payer: Banner UC Health Medicare	$83.10
Rate for Payer: Bisbee Police All Plans	$144.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$376.72
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cigna of AZ Commercial	$360.10
Rate for Payer: Copperpoint Commercial	$137.12
Rate for Payer: Health Net of AZ Commercial	$332.40
Rate for Payer: Health Net of AZ Medicare	$155.12
Rate for Payer: Humana of AZ Medicare	$83.10
Rate for Payer: Mercy Care Medicaid	$18.40
Rate for Payer: Self Pay Self Pay	$443.20
Rate for Payer: TriWest Medicare	$83.10
Rate for Payer: UnitedHealth Group of AZ Commercial	$322.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$99.72

AChR Binding Abs LC

Facility

$554.00

Service Code	CPT 83519
Hospital Charge Code	6738702
Hospital Revenue Code	301
Min. Negotiated Rate	$144.04
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna of AZ Commercial	$498.60
Rate for Payer: Bisbee Police All Plans	$144.04
Rate for Payer: Cash Price	$443.20
Rate for Payer: Self Pay Self Pay	$443.20

ACTH, Plasma LC

Facility

$482.00

Service Code	CPT 82024
Hospital Charge Code	1905879
Hospital Revenue Code	301
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Cash Price	$385.60
Rate for Payer: Self Pay Self Pay	$385.60

ACTH, Plasma LC

Facility

$482.00

Service Code	CPT 82024
Hospital Charge Code	1905879
Hospital Revenue Code	301
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$433.80
Rate for Payer: Aetna of AZ Commercial	$433.80
Rate for Payer: Aetna of AZ Medicare	$134.96
Rate for Payer: AHCCCS Medicaid	$38.62
Rate for Payer: Allwell Medicaid	$38.62
Rate for Payer: Allwell Medicare	$72.30
Rate for Payer: Amerigroup Medicare	$72.30
Rate for Payer: APIPA Medicare/Medicaid	$180.03
Rate for Payer: AZCH Complete Medicaid	$38.62
Rate for Payer: AZCH Complete Medicare	$72.30
Rate for Payer: Banner UC Health Medicaid	$38.62
Rate for Payer: Banner UC Health Medicare	$72.30
Rate for Payer: Bisbee Police All Plans	$125.32
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$327.76
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cigna of AZ Commercial	$313.30
Rate for Payer: Copperpoint Commercial	$119.30
Rate for Payer: Health Net of AZ Commercial	$289.20
Rate for Payer: Health Net of AZ Medicare	$134.96
Rate for Payer: Humana of AZ Medicare	$72.30
Rate for Payer: Mercy Care Medicaid	$38.62
Rate for Payer: Self Pay Self Pay	$385.60
Rate for Payer: TriWest Medicare	$72.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.76

Know your out-of-pocket cost for care.

All Charges