Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

propranolol 20 mg Tab [CQCH]

Facility

$0.45

Service Code	NDC 60687059801
Hospital Charge Code	105953054
Hospital Revenue Code	251
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna of AZ Commercial	$0.41
Rate for Payer: Aetna of AZ Medicare	$0.13
Rate for Payer: Allwell Medicare	$0.07
Rate for Payer: Amerigroup Medicare	$0.07
Rate for Payer: APIPA Medicare/Medicaid	$0.17
Rate for Payer: AZCH Complete Medicare	$0.07
Rate for Payer: Banner UC Health Medicare	$0.07
Rate for Payer: Bisbee Police All Plans	$0.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.31
Rate for Payer: Cash Price	$0.36
Rate for Payer: Cigna of AZ Commercial	$0.29
Rate for Payer: Copperpoint Commercial	$0.11
Rate for Payer: Health Net of AZ Commercial	$0.27
Rate for Payer: Health Net of AZ Medicare	$0.13
Rate for Payer: Humana of AZ Medicare	$0.07
Rate for Payer: Self Pay Self Pay	$0.36
Rate for Payer: TriWest Medicare	$0.07
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.26
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.08

protamine 250 mg/25 mL Inj Sol [CQCH]

Facility

$1.32

Service Code	HCPCS J2720
Hospital Charge Code	105938671
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$1.94
Rate for Payer: Aetna of AZ Commercial	$1.19
Rate for Payer: Aetna of AZ Medicare	$0.37
Rate for Payer: AHCCCS Medicaid	$1.94
Rate for Payer: Allwell Medicaid	$1.94
Rate for Payer: Allwell Medicare	$0.20
Rate for Payer: Amerigroup Medicare	$0.20
Rate for Payer: APIPA Medicare/Medicaid	$0.49
Rate for Payer: AZCH Complete Medicaid	$1.94
Rate for Payer: AZCH Complete Medicare	$0.20
Rate for Payer: Banner UC Health Medicaid	$1.94
Rate for Payer: Banner UC Health Medicare	$0.20
Rate for Payer: Bisbee Police All Plans	$0.34
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.90
Rate for Payer: Cash Price	$1.06
Rate for Payer: Cash Price	$1.06
Rate for Payer: Cigna of AZ Commercial	$0.86
Rate for Payer: Copperpoint Commercial	$0.33
Rate for Payer: Health Net of AZ Commercial	$0.79
Rate for Payer: Health Net of AZ Medicare	$0.37
Rate for Payer: Humana of AZ Medicare	$0.20
Rate for Payer: Mercy Care Medicaid	$1.94
Rate for Payer: Self Pay Self Pay	$1.06
Rate for Payer: TriWest Medicare	$0.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.77
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.24

protamine 250 mg/25 mL Inj Sol [CQCH]

Facility

$1.32

Service Code	HCPCS J2720
Hospital Charge Code	105938671
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$1.19
Rate for Payer: Aetna of AZ Commercial	$1.19
Rate for Payer: Bisbee Police All Plans	$0.34
Rate for Payer: Cash Price	$1.06
Rate for Payer: Self Pay Self Pay	$1.06

Protein 24 Hour Urine

Facility

$71.00

Service Code	CPT 84133
Hospital Charge Code	633811
Hospital Revenue Code	301
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Cash Price	$56.80
Rate for Payer: Self Pay Self Pay	$56.80

Protein 24 Hour Urine

Facility

$71.00

Service Code	CPT 84133
Hospital Charge Code	633811
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$63.90
Rate for Payer: Aetna of AZ Commercial	$63.90
Rate for Payer: Aetna of AZ Medicare	$19.88
Rate for Payer: AHCCCS Medicaid	$4.73
Rate for Payer: Allwell Medicaid	$4.73
Rate for Payer: Allwell Medicare	$10.65
Rate for Payer: Amerigroup Medicare	$10.65
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicaid	$4.73
Rate for Payer: AZCH Complete Medicare	$10.65
Rate for Payer: Banner UC Health Medicaid	$4.73
Rate for Payer: Banner UC Health Medicare	$10.65
Rate for Payer: Bisbee Police All Plans	$18.46
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$48.28
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cigna of AZ Commercial	$46.15
Rate for Payer: Copperpoint Commercial	$17.57
Rate for Payer: Health Net of AZ Commercial	$42.60
Rate for Payer: Health Net of AZ Medicare	$19.88
Rate for Payer: Humana of AZ Medicare	$10.65
Rate for Payer: Mercy Care Medicaid	$4.73
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$10.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

Protein C Activity (Chrom) LC

Facility

$172.00

Service Code	CPT 85303
Hospital Charge Code	6781142
Hospital Revenue Code	301
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Aetna of AZ Medicare	$48.16
Rate for Payer: AHCCCS Medicaid	$13.84
Rate for Payer: Allwell Medicaid	$13.84
Rate for Payer: Allwell Medicare	$25.80
Rate for Payer: Amerigroup Medicare	$25.80
Rate for Payer: APIPA Medicare/Medicaid	$64.24
Rate for Payer: AZCH Complete Medicaid	$13.84
Rate for Payer: AZCH Complete Medicare	$25.80
Rate for Payer: Banner UC Health Medicaid	$13.84
Rate for Payer: Banner UC Health Medicare	$25.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$116.96
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cigna of AZ Commercial	$111.80
Rate for Payer: Copperpoint Commercial	$42.57
Rate for Payer: Health Net of AZ Commercial	$103.20
Rate for Payer: Health Net of AZ Medicare	$48.16
Rate for Payer: Humana of AZ Medicare	$25.80
Rate for Payer: Mercy Care Medicaid	$13.84
Rate for Payer: Self Pay Self Pay	$137.60
Rate for Payer: TriWest Medicare	$25.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$100.28
Rate for Payer: UnitedHealth Group of AZ Medicare	$30.96

Protein C Activity (Chrom) LC

Facility

$172.00

Service Code	CPT 85303
Hospital Charge Code	6781142
Hospital Revenue Code	301
Min. Negotiated Rate	$44.72
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna of AZ Commercial	$154.80
Rate for Payer: Bisbee Police All Plans	$44.72
Rate for Payer: Cash Price	$137.60
Rate for Payer: Self Pay Self Pay	$137.60

Protein C Deficiency Profile LC

Facility

$427.00

Service Code	CPT 85302
Hospital Charge Code	2087638
Hospital Revenue Code	305
Min. Negotiated Rate	$111.02
Max. Negotiated Rate	$384.30
Rate for Payer: Aetna of AZ Commercial	$384.30
Rate for Payer: Bisbee Police All Plans	$111.02
Rate for Payer: Cash Price	$341.60
Rate for Payer: Self Pay Self Pay	$341.60

Protein C Deficiency Profile LC

Facility

$427.00

Service Code	CPT 85302
Hospital Charge Code	2087638
Hospital Revenue Code	305
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$384.30
Rate for Payer: Aetna of AZ Commercial	$384.30
Rate for Payer: Aetna of AZ Medicare	$119.56
Rate for Payer: AHCCCS Medicaid	$12.01
Rate for Payer: Allwell Medicaid	$12.01
Rate for Payer: Allwell Medicare	$64.05
Rate for Payer: Amerigroup Medicare	$64.05
Rate for Payer: APIPA Medicare/Medicaid	$159.48
Rate for Payer: AZCH Complete Medicaid	$12.01
Rate for Payer: AZCH Complete Medicare	$64.05
Rate for Payer: Banner UC Health Medicaid	$12.01
Rate for Payer: Banner UC Health Medicare	$64.05
Rate for Payer: Bisbee Police All Plans	$111.02
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$290.36
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cigna of AZ Commercial	$277.55
Rate for Payer: Copperpoint Commercial	$105.68
Rate for Payer: Health Net of AZ Commercial	$256.20
Rate for Payer: Health Net of AZ Medicare	$119.56
Rate for Payer: Humana of AZ Medicare	$64.05
Rate for Payer: Mercy Care Medicaid	$12.01
Rate for Payer: Self Pay Self Pay	$341.60
Rate for Payer: TriWest Medicare	$64.05
Rate for Payer: UnitedHealth Group of AZ Commercial	$248.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$76.86

Protein Electro, 24-Hour Urine LC

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	1285721
Hospital Revenue Code	301
Min. Negotiated Rate	$210.08
Max. Negotiated Rate	$727.20
Rate for Payer: Aetna of AZ Commercial	$727.20
Rate for Payer: Bisbee Police All Plans	$210.08
Rate for Payer: Cash Price	$646.40
Rate for Payer: Self Pay Self Pay	$646.40

Protein Electro, 24-Hour Urine LC

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	1285721
Hospital Revenue Code	301
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$727.20
Rate for Payer: Aetna of AZ Commercial	$727.20
Rate for Payer: Aetna of AZ Medicare	$226.24
Rate for Payer: AHCCCS Medicaid	$17.83
Rate for Payer: Allwell Medicaid	$17.83
Rate for Payer: Allwell Medicare	$121.20
Rate for Payer: Amerigroup Medicare	$121.20
Rate for Payer: APIPA Medicare/Medicaid	$301.79
Rate for Payer: AZCH Complete Medicaid	$17.83
Rate for Payer: AZCH Complete Medicare	$121.20
Rate for Payer: Banner UC Health Medicaid	$17.83
Rate for Payer: Banner UC Health Medicare	$121.20
Rate for Payer: Bisbee Police All Plans	$210.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$549.44
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cigna of AZ Commercial	$525.20
Rate for Payer: Copperpoint Commercial	$199.98
Rate for Payer: Health Net of AZ Commercial	$484.80
Rate for Payer: Health Net of AZ Medicare	$226.24
Rate for Payer: Humana of AZ Medicare	$121.20
Rate for Payer: Mercy Care Medicaid	$17.83
Rate for Payer: Self Pay Self Pay	$646.40
Rate for Payer: TriWest Medicare	$121.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$471.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.44

Protein Electro, Random Urine LC

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	2087639
Hospital Revenue Code	301
Min. Negotiated Rate	$210.08
Max. Negotiated Rate	$727.20
Rate for Payer: Aetna of AZ Commercial	$727.20
Rate for Payer: Bisbee Police All Plans	$210.08
Rate for Payer: Cash Price	$646.40
Rate for Payer: Self Pay Self Pay	$646.40

Protein Electro, Random Urine LC

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	2087639
Hospital Revenue Code	301
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$727.20
Rate for Payer: Aetna of AZ Commercial	$727.20
Rate for Payer: Aetna of AZ Medicare	$226.24
Rate for Payer: AHCCCS Medicaid	$17.83
Rate for Payer: Allwell Medicaid	$17.83
Rate for Payer: Allwell Medicare	$121.20
Rate for Payer: Amerigroup Medicare	$121.20
Rate for Payer: APIPA Medicare/Medicaid	$301.79
Rate for Payer: AZCH Complete Medicaid	$17.83
Rate for Payer: AZCH Complete Medicare	$121.20
Rate for Payer: Banner UC Health Medicaid	$17.83
Rate for Payer: Banner UC Health Medicare	$121.20
Rate for Payer: Bisbee Police All Plans	$210.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$549.44
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cigna of AZ Commercial	$525.20
Rate for Payer: Copperpoint Commercial	$199.98
Rate for Payer: Health Net of AZ Commercial	$484.80
Rate for Payer: Health Net of AZ Medicare	$226.24
Rate for Payer: Humana of AZ Medicare	$121.20
Rate for Payer: Mercy Care Medicaid	$17.83
Rate for Payer: Self Pay Self Pay	$646.40
Rate for Payer: TriWest Medicare	$121.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$471.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.44

Protein Electro Serum LC

Facility

$717.00

Service Code	CPT 84165
Hospital Charge Code	1285802
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Aetna of AZ Medicare	$200.76
Rate for Payer: AHCCCS Medicaid	$10.74
Rate for Payer: Allwell Medicaid	$10.74
Rate for Payer: Allwell Medicare	$107.55
Rate for Payer: Amerigroup Medicare	$107.55
Rate for Payer: APIPA Medicare/Medicaid	$267.80
Rate for Payer: AZCH Complete Medicaid	$10.74
Rate for Payer: AZCH Complete Medicare	$107.55
Rate for Payer: Banner UC Health Medicaid	$10.74
Rate for Payer: Banner UC Health Medicare	$107.55
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$487.56
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cigna of AZ Commercial	$466.05
Rate for Payer: Copperpoint Commercial	$177.46
Rate for Payer: Health Net of AZ Commercial	$430.20
Rate for Payer: Health Net of AZ Medicare	$200.76
Rate for Payer: Humana of AZ Medicare	$107.55
Rate for Payer: Mercy Care Medicaid	$10.74
Rate for Payer: Self Pay Self Pay	$573.60
Rate for Payer: TriWest Medicare	$107.55
Rate for Payer: UnitedHealth Group of AZ Commercial	$418.01
Rate for Payer: UnitedHealth Group of AZ Medicare	$129.06

Protein Electro Serum LC

Facility

$717.00

Service Code	CPT 84165
Hospital Charge Code	1285802
Hospital Revenue Code	301
Min. Negotiated Rate	$186.42
Max. Negotiated Rate	$645.30
Rate for Payer: Aetna of AZ Commercial	$645.30
Rate for Payer: Bisbee Police All Plans	$186.42
Rate for Payer: Cash Price	$573.60
Rate for Payer: Self Pay Self Pay	$573.60

Protein Level Urine

Facility

$100.00

Service Code	CPT 84156
Hospital Charge Code	12253376
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Aetna of AZ Medicare	$28.00
Rate for Payer: AHCCCS Medicaid	$3.67
Rate for Payer: Allwell Medicaid	$3.67
Rate for Payer: Allwell Medicare	$15.00
Rate for Payer: Amerigroup Medicare	$15.00
Rate for Payer: APIPA Medicare/Medicaid	$37.35
Rate for Payer: AZCH Complete Medicaid	$3.67
Rate for Payer: AZCH Complete Medicare	$15.00
Rate for Payer: Banner UC Health Medicaid	$3.67
Rate for Payer: Banner UC Health Medicare	$15.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$68.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna of AZ Commercial	$65.00
Rate for Payer: Copperpoint Commercial	$24.75
Rate for Payer: Health Net of AZ Commercial	$60.00
Rate for Payer: Health Net of AZ Medicare	$28.00
Rate for Payer: Humana of AZ Medicare	$15.00
Rate for Payer: Mercy Care Medicaid	$3.67
Rate for Payer: Self Pay Self Pay	$80.00
Rate for Payer: TriWest Medicare	$15.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$58.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$18.00

Protein Level Urine

Facility

$100.00

Service Code	CPT 84156
Hospital Charge Code	12253376
Hospital Revenue Code	301
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna of AZ Commercial	$90.00
Rate for Payer: Bisbee Police All Plans	$26.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Self Pay Self Pay	$80.00

Protein S-Functional LC

Facility

$189.00

Service Code	CPT 85306
Hospital Charge Code	2087641
Hospital Revenue Code	301
Min. Negotiated Rate	$49.14
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Cash Price	$151.20
Rate for Payer: Self Pay Self Pay	$151.20

Protein S-Functional LC

Facility

$189.00

Service Code	CPT 85306
Hospital Charge Code	2087641
Hospital Revenue Code	301
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna of AZ Commercial	$170.10
Rate for Payer: Aetna of AZ Medicare	$52.92
Rate for Payer: AHCCCS Medicaid	$15.32
Rate for Payer: Allwell Medicaid	$15.32
Rate for Payer: Allwell Medicare	$28.35
Rate for Payer: Amerigroup Medicare	$28.35
Rate for Payer: APIPA Medicare/Medicaid	$70.59
Rate for Payer: AZCH Complete Medicaid	$15.32
Rate for Payer: AZCH Complete Medicare	$28.35
Rate for Payer: Banner UC Health Medicaid	$15.32
Rate for Payer: Banner UC Health Medicare	$28.35
Rate for Payer: Bisbee Police All Plans	$49.14
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$128.52
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna of AZ Commercial	$122.85
Rate for Payer: Copperpoint Commercial	$46.78
Rate for Payer: Health Net of AZ Commercial	$113.40
Rate for Payer: Health Net of AZ Medicare	$52.92
Rate for Payer: Humana of AZ Medicare	$28.35
Rate for Payer: Mercy Care Medicaid	$15.32
Rate for Payer: Self Pay Self Pay	$151.20
Rate for Payer: TriWest Medicare	$28.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$110.19
Rate for Payer: UnitedHealth Group of AZ Medicare	$34.02

Protein S Panel LC

Facility

$1,129.00

Service Code	CPT 85306
Hospital Charge Code	2087640
Hospital Revenue Code	305
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$1,016.10
Rate for Payer: Aetna of AZ Commercial	$1,016.10
Rate for Payer: Aetna of AZ Medicare	$316.12
Rate for Payer: AHCCCS Medicaid	$15.32
Rate for Payer: Allwell Medicaid	$15.32
Rate for Payer: Allwell Medicare	$169.35
Rate for Payer: Amerigroup Medicare	$169.35
Rate for Payer: APIPA Medicare/Medicaid	$421.68
Rate for Payer: AZCH Complete Medicaid	$15.32
Rate for Payer: AZCH Complete Medicare	$169.35
Rate for Payer: Banner UC Health Medicaid	$15.32
Rate for Payer: Banner UC Health Medicare	$169.35
Rate for Payer: Bisbee Police All Plans	$293.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$767.72
Rate for Payer: Cash Price	$903.20
Rate for Payer: Cash Price	$903.20
Rate for Payer: Cigna of AZ Commercial	$733.85
Rate for Payer: Copperpoint Commercial	$279.43
Rate for Payer: Health Net of AZ Commercial	$677.40
Rate for Payer: Health Net of AZ Medicare	$316.12
Rate for Payer: Humana of AZ Medicare	$169.35
Rate for Payer: Mercy Care Medicaid	$15.32
Rate for Payer: Self Pay Self Pay	$903.20
Rate for Payer: TriWest Medicare	$169.35
Rate for Payer: UnitedHealth Group of AZ Commercial	$658.21
Rate for Payer: UnitedHealth Group of AZ Medicare	$203.22

Protein S Panel LC

Facility

$1,129.00

Service Code	CPT 85306
Hospital Charge Code	2087640
Hospital Revenue Code	305
Min. Negotiated Rate	$293.54
Max. Negotiated Rate	$1,016.10
Rate for Payer: Aetna of AZ Commercial	$1,016.10
Rate for Payer: Bisbee Police All Plans	$293.54
Rate for Payer: Cash Price	$903.20
Rate for Payer: Self Pay Self Pay	$903.20

Protein Total

Facility

$83.00

Service Code	CPT 84155
Hospital Charge Code	633818
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Aetna of AZ Medicare	$23.24
Rate for Payer: AHCCCS Medicaid	$3.67
Rate for Payer: Allwell Medicaid	$3.67
Rate for Payer: Allwell Medicare	$12.45
Rate for Payer: Amerigroup Medicare	$12.45
Rate for Payer: APIPA Medicare/Medicaid	$31.00
Rate for Payer: AZCH Complete Medicaid	$3.67
Rate for Payer: AZCH Complete Medicare	$12.45
Rate for Payer: Banner UC Health Medicaid	$3.67
Rate for Payer: Banner UC Health Medicare	$12.45
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$56.44
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cigna of AZ Commercial	$53.95
Rate for Payer: Copperpoint Commercial	$20.54
Rate for Payer: Health Net of AZ Commercial	$49.80
Rate for Payer: Health Net of AZ Medicare	$23.24
Rate for Payer: Humana of AZ Medicare	$12.45
Rate for Payer: Mercy Care Medicaid	$3.67
Rate for Payer: Self Pay Self Pay	$66.40
Rate for Payer: TriWest Medicare	$12.45
Rate for Payer: UnitedHealth Group of AZ Commercial	$48.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.94

Protein Total

Facility

$83.00

Service Code	CPT 84155
Hospital Charge Code	633818
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna of AZ Commercial	$74.70
Rate for Payer: Bisbee Police All Plans	$21.58
Rate for Payer: Cash Price	$66.40
Rate for Payer: Self Pay Self Pay	$66.40

Protein total CSF

Facility

$91.00

Service Code	CPT 84157
Hospital Charge Code	633813
Hospital Revenue Code	301
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Cash Price	$72.80
Rate for Payer: Self Pay Self Pay	$72.80

Protein total CSF

Facility

$91.00

Service Code	CPT 84157
Hospital Charge Code	633813
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna of AZ Commercial	$81.90
Rate for Payer: Aetna of AZ Medicare	$25.48
Rate for Payer: AHCCCS Medicaid	$4.00
Rate for Payer: Allwell Medicaid	$4.00
Rate for Payer: Allwell Medicare	$13.65
Rate for Payer: Amerigroup Medicare	$13.65
Rate for Payer: APIPA Medicare/Medicaid	$33.99
Rate for Payer: AZCH Complete Medicaid	$4.00
Rate for Payer: AZCH Complete Medicare	$13.65
Rate for Payer: Banner UC Health Medicaid	$4.00
Rate for Payer: Banner UC Health Medicare	$13.65
Rate for Payer: Bisbee Police All Plans	$23.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$61.88
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cigna of AZ Commercial	$59.15
Rate for Payer: Copperpoint Commercial	$22.52
Rate for Payer: Health Net of AZ Commercial	$54.60
Rate for Payer: Health Net of AZ Medicare	$25.48
Rate for Payer: Humana of AZ Medicare	$13.65
Rate for Payer: Mercy Care Medicaid	$4.00
Rate for Payer: Self Pay Self Pay	$72.80
Rate for Payer: TriWest Medicare	$13.65
Rate for Payer: UnitedHealth Group of AZ Commercial	$53.05
Rate for Payer: UnitedHealth Group of AZ Medicare	$16.38

Know your out-of-pocket cost for care.

All Charges