Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Protein Electro, Random Urine LC

Facility

$768.00

Service Code	CPT 84166
Hospital Charge Code	2087639
Hospital Revenue Code	301
Min. Negotiated Rate	$199.68
Max. Negotiated Rate	$691.20
Rate for Payer: Aetna of AZ Commercial	$691.20
Rate for Payer: Bisbee Police All Plans	$199.68
Rate for Payer: Cash Price	$614.40
Rate for Payer: Self Pay Self Pay	$614.40

Protein Electro, Random Urine LC

Facility

$768.00

Service Code	CPT 84166
Hospital Charge Code	2087639
Hospital Revenue Code	301
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$691.20
Rate for Payer: Aetna of AZ Commercial	$691.20
Rate for Payer: Aetna of AZ Medicare	$215.04
Rate for Payer: Allwell Medicare	$122.88
Rate for Payer: Amerigroup Medicare	$122.88
Rate for Payer: APIPA Medicare/Medicaid	$286.85
Rate for Payer: AZCH Complete Medicare	$122.88
Rate for Payer: Banner UC Health Medicare	$122.88
Rate for Payer: Bisbee Police All Plans	$199.68
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$522.24
Rate for Payer: Cash Price	$614.40
Rate for Payer: Cigna of AZ Commercial	$499.20
Rate for Payer: Copperpoint Commercial	$190.08
Rate for Payer: Health Net of AZ Commercial	$460.80
Rate for Payer: Health Net of AZ Medicare	$215.04
Rate for Payer: Humana of AZ Medicare	$122.88
Rate for Payer: Self Pay Self Pay	$614.40
Rate for Payer: TriWest Medicare	$122.88
Rate for Payer: UnitedHealth Group of AZ Commercial	$447.74
Rate for Payer: UnitedHealth Group of AZ Medicare	$138.24

Protein Electro Serum LC

Facility

$681.00

Service Code	CPT 84165
Hospital Charge Code	1285802
Hospital Revenue Code	301
Min. Negotiated Rate	$108.96
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Aetna of AZ Medicare	$190.68
Rate for Payer: Allwell Medicare	$108.96
Rate for Payer: Amerigroup Medicare	$108.96
Rate for Payer: APIPA Medicare/Medicaid	$254.35
Rate for Payer: AZCH Complete Medicare	$108.96
Rate for Payer: Banner UC Health Medicare	$108.96
Rate for Payer: Bisbee Police All Plans	$177.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$463.08
Rate for Payer: Cash Price	$544.80
Rate for Payer: Cigna of AZ Commercial	$442.65
Rate for Payer: Copperpoint Commercial	$168.55
Rate for Payer: Health Net of AZ Commercial	$408.60
Rate for Payer: Health Net of AZ Medicare	$190.68
Rate for Payer: Humana of AZ Medicare	$108.96
Rate for Payer: Self Pay Self Pay	$544.80
Rate for Payer: TriWest Medicare	$108.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$397.02
Rate for Payer: UnitedHealth Group of AZ Medicare	$122.58

Protein Electro Serum LC

Facility

$681.00

Service Code	CPT 84165
Hospital Charge Code	1285802
Hospital Revenue Code	301
Min. Negotiated Rate	$177.06
Max. Negotiated Rate	$612.90
Rate for Payer: Aetna of AZ Commercial	$612.90
Rate for Payer: Bisbee Police All Plans	$177.06
Rate for Payer: Cash Price	$544.80
Rate for Payer: Self Pay Self Pay	$544.80

Protein Level Urine

Facility

$95.00

Service Code	CPT 84156
Hospital Charge Code	12253376
Hospital Revenue Code	301
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Aetna of AZ Medicare	$26.60
Rate for Payer: Allwell Medicare	$15.20
Rate for Payer: Amerigroup Medicare	$15.20
Rate for Payer: APIPA Medicare/Medicaid	$35.48
Rate for Payer: AZCH Complete Medicare	$15.20
Rate for Payer: Banner UC Health Medicare	$15.20
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$64.60
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cigna of AZ Commercial	$61.75
Rate for Payer: Copperpoint Commercial	$23.51
Rate for Payer: Health Net of AZ Commercial	$57.00
Rate for Payer: Health Net of AZ Medicare	$26.60
Rate for Payer: Humana of AZ Medicare	$15.20
Rate for Payer: Self Pay Self Pay	$76.00
Rate for Payer: TriWest Medicare	$15.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$55.38
Rate for Payer: UnitedHealth Group of AZ Medicare	$17.10

Protein Level Urine

Facility

$95.00

Service Code	CPT 84156
Hospital Charge Code	12253376
Hospital Revenue Code	301
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna of AZ Commercial	$85.50
Rate for Payer: Bisbee Police All Plans	$24.70
Rate for Payer: Cash Price	$76.00
Rate for Payer: Self Pay Self Pay	$76.00

Protein S-Functional LC

Facility

$180.00

Service Code	CPT 85306
Hospital Charge Code	2087641
Hospital Revenue Code	301
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Self Pay Self Pay	$144.00

Protein S-Functional LC

Facility

$180.00

Service Code	CPT 85306
Hospital Charge Code	2087641
Hospital Revenue Code	301
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna of AZ Commercial	$162.00
Rate for Payer: Aetna of AZ Medicare	$50.40
Rate for Payer: Allwell Medicare	$28.80
Rate for Payer: Amerigroup Medicare	$28.80
Rate for Payer: APIPA Medicare/Medicaid	$67.23
Rate for Payer: AZCH Complete Medicare	$28.80
Rate for Payer: Banner UC Health Medicare	$28.80
Rate for Payer: Bisbee Police All Plans	$46.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$122.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of AZ Commercial	$117.00
Rate for Payer: Copperpoint Commercial	$44.55
Rate for Payer: Health Net of AZ Commercial	$108.00
Rate for Payer: Health Net of AZ Medicare	$50.40
Rate for Payer: Humana of AZ Medicare	$28.80
Rate for Payer: Self Pay Self Pay	$144.00
Rate for Payer: TriWest Medicare	$28.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$104.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$32.40

Protein S Panel LC

Facility

$1,073.00

Service Code	CPT 85306
Hospital Charge Code	2087640
Hospital Revenue Code	305
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$965.70
Rate for Payer: Aetna of AZ Commercial	$965.70
Rate for Payer: Aetna of AZ Medicare	$300.44
Rate for Payer: Allwell Medicare	$171.68
Rate for Payer: Amerigroup Medicare	$171.68
Rate for Payer: APIPA Medicare/Medicaid	$400.77
Rate for Payer: AZCH Complete Medicare	$171.68
Rate for Payer: Banner UC Health Medicare	$171.68
Rate for Payer: Bisbee Police All Plans	$278.98
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$729.64
Rate for Payer: Cash Price	$858.40
Rate for Payer: Cigna of AZ Commercial	$697.45
Rate for Payer: Copperpoint Commercial	$265.57
Rate for Payer: Health Net of AZ Commercial	$643.80
Rate for Payer: Health Net of AZ Medicare	$300.44
Rate for Payer: Humana of AZ Medicare	$171.68
Rate for Payer: Self Pay Self Pay	$858.40
Rate for Payer: TriWest Medicare	$171.68
Rate for Payer: UnitedHealth Group of AZ Commercial	$625.56
Rate for Payer: UnitedHealth Group of AZ Medicare	$193.14

Protein S Panel LC

Facility

$1,073.00

Service Code	CPT 85306
Hospital Charge Code	2087640
Hospital Revenue Code	305
Min. Negotiated Rate	$278.98
Max. Negotiated Rate	$965.70
Rate for Payer: Aetna of AZ Commercial	$965.70
Rate for Payer: Bisbee Police All Plans	$278.98
Rate for Payer: Cash Price	$858.40
Rate for Payer: Self Pay Self Pay	$858.40

Protein Total

Facility

$79.00

Service Code	CPT 84155
Hospital Charge Code	633818
Hospital Revenue Code	301
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Cash Price	$63.20
Rate for Payer: Self Pay Self Pay	$63.20

Protein Total

Facility

$79.00

Service Code	CPT 84155
Hospital Charge Code	633818
Hospital Revenue Code	301
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna of AZ Commercial	$71.10
Rate for Payer: Aetna of AZ Medicare	$22.12
Rate for Payer: Allwell Medicare	$12.64
Rate for Payer: Amerigroup Medicare	$12.64
Rate for Payer: APIPA Medicare/Medicaid	$29.51
Rate for Payer: AZCH Complete Medicare	$12.64
Rate for Payer: Banner UC Health Medicare	$12.64
Rate for Payer: Bisbee Police All Plans	$20.54
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.72
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cigna of AZ Commercial	$51.35
Rate for Payer: Copperpoint Commercial	$19.55
Rate for Payer: Health Net of AZ Commercial	$47.40
Rate for Payer: Health Net of AZ Medicare	$22.12
Rate for Payer: Humana of AZ Medicare	$12.64
Rate for Payer: Self Pay Self Pay	$63.20
Rate for Payer: TriWest Medicare	$12.64
Rate for Payer: UnitedHealth Group of AZ Commercial	$46.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.22

Protein total CSF

Facility

$86.00

Service Code	CPT 84157
Hospital Charge Code	633813
Hospital Revenue Code	301
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Bisbee Police All Plans	$22.36
Rate for Payer: Cash Price	$68.80
Rate for Payer: Self Pay Self Pay	$68.80

Protein total CSF

Facility

$86.00

Service Code	CPT 84157
Hospital Charge Code	633813
Hospital Revenue Code	301
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$77.40
Rate for Payer: Aetna of AZ Commercial	$77.40
Rate for Payer: Aetna of AZ Medicare	$24.08
Rate for Payer: Allwell Medicare	$13.76
Rate for Payer: Amerigroup Medicare	$13.76
Rate for Payer: APIPA Medicare/Medicaid	$32.12
Rate for Payer: AZCH Complete Medicare	$13.76
Rate for Payer: Banner UC Health Medicare	$13.76
Rate for Payer: Bisbee Police All Plans	$22.36
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$58.48
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cigna of AZ Commercial	$55.90
Rate for Payer: Copperpoint Commercial	$21.29
Rate for Payer: Health Net of AZ Commercial	$51.60
Rate for Payer: Health Net of AZ Medicare	$24.08
Rate for Payer: Humana of AZ Medicare	$13.76
Rate for Payer: Self Pay Self Pay	$68.80
Rate for Payer: TriWest Medicare	$13.76
Rate for Payer: UnitedHealth Group of AZ Commercial	$50.14
Rate for Payer: UnitedHealth Group of AZ Medicare	$15.48

PROT EL 24 HR

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	22481495
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

PROT EL 24 HR

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	22481495
Hospital Revenue Code	301
Min. Negotiated Rate	$129.28
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: Allwell Medicare	$129.28
Rate for Payer: Amerigroup Medicare	$129.28
Rate for Payer: APIPA Medicare/Medicaid	$301.79
Rate for Payer: AZCH Complete Medicare	$129.28
Rate for Payer: Banner UC Health Medicare	$129.28
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: 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	$129.28
Rate for Payer: Self Pay Self Pay	$646.40
Rate for Payer: TriWest Medicare	$129.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$471.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.44

PROT EL R UR

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	22481496
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

PROT EL R UR

Facility

$808.00

Service Code	CPT 84166
Hospital Charge Code	22481496
Hospital Revenue Code	301
Min. Negotiated Rate	$129.28
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: Allwell Medicare	$129.28
Rate for Payer: Amerigroup Medicare	$129.28
Rate for Payer: APIPA Medicare/Medicaid	$301.79
Rate for Payer: AZCH Complete Medicare	$129.28
Rate for Payer: Banner UC Health Medicare	$129.28
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: 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	$129.28
Rate for Payer: Self Pay Self Pay	$646.40
Rate for Payer: TriWest Medicare	$129.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$471.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$145.44

prothrombin complex - REC[CQCH]

Facility

$1,910.00

Service Code	HCPCS C9132
Hospital Charge Code	182934642
Hospital Revenue Code	250
Min. Negotiated Rate	$305.60
Max. Negotiated Rate	$1,719.00
Rate for Payer: Aetna of AZ Commercial	$1,719.00
Rate for Payer: Aetna of AZ Medicare	$534.80
Rate for Payer: Allwell Medicare	$305.60
Rate for Payer: Amerigroup Medicare	$305.60
Rate for Payer: APIPA Medicare/Medicaid	$713.38
Rate for Payer: AZCH Complete Medicare	$305.60
Rate for Payer: Banner UC Health Medicare	$305.60
Rate for Payer: Bisbee Police All Plans	$496.60
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,298.80
Rate for Payer: Cash Price	$1,528.00
Rate for Payer: Cigna of AZ Commercial	$1,241.50
Rate for Payer: Copperpoint Commercial	$472.73
Rate for Payer: Health Net of AZ Commercial	$1,146.00
Rate for Payer: Health Net of AZ Medicare	$534.80
Rate for Payer: Humana of AZ Medicare	$305.60
Rate for Payer: Self Pay Self Pay	$1,528.00
Rate for Payer: TriWest Medicare	$305.60
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,113.53
Rate for Payer: UnitedHealth Group of AZ Medicare	$343.80

prothrombin complex - REC[CQCH]

Facility

$1,910.00

Service Code	HCPCS C9132
Hospital Charge Code	182934642
Hospital Revenue Code	250
Min. Negotiated Rate	$496.60
Max. Negotiated Rate	$1,719.00
Rate for Payer: Aetna of AZ Commercial	$1,719.00
Rate for Payer: Bisbee Police All Plans	$496.60
Rate for Payer: Cash Price	$1,528.00
Rate for Payer: Self Pay Self Pay	$1,528.00

Prothrombin/INR POC

Facility

$71.00

Service Code	CPT 85610
Hospital Charge Code	714167
Hospital Revenue Code	305
Min. Negotiated Rate	$11.36
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: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
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: 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	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

Prothrombin/INR POC

Facility

$71.00

Service Code	CPT 85610
Hospital Charge Code	714167
Hospital Revenue Code	305
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

Prothrombin Time

Facility

$67.00

Service Code	CPT 85610
Hospital Charge Code	633793
Hospital Revenue Code	305
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Cash Price	$53.60
Rate for Payer: Self Pay Self Pay	$53.60

Prothrombin Time

Facility

$67.00

Service Code	CPT 85610
Hospital Charge Code	633793
Hospital Revenue Code	305
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$60.30
Rate for Payer: Aetna of AZ Commercial	$60.30
Rate for Payer: Aetna of AZ Medicare	$18.76
Rate for Payer: Allwell Medicare	$10.72
Rate for Payer: Amerigroup Medicare	$10.72
Rate for Payer: APIPA Medicare/Medicaid	$25.02
Rate for Payer: AZCH Complete Medicare	$10.72
Rate for Payer: Banner UC Health Medicare	$10.72
Rate for Payer: Bisbee Police All Plans	$17.42
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$45.56
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cigna of AZ Commercial	$43.55
Rate for Payer: Copperpoint Commercial	$16.58
Rate for Payer: Health Net of AZ Commercial	$40.20
Rate for Payer: Health Net of AZ Medicare	$18.76
Rate for Payer: Humana of AZ Medicare	$10.72
Rate for Payer: Self Pay Self Pay	$53.60
Rate for Payer: TriWest Medicare	$10.72
Rate for Payer: UnitedHealth Group of AZ Commercial	$39.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.06

PROTIME

Facility

$71.00

Service Code	CPT 85610
Hospital Charge Code	22481498
Hospital Revenue Code	305
Min. Negotiated Rate	$11.36
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: Allwell Medicare	$11.36
Rate for Payer: Amerigroup Medicare	$11.36
Rate for Payer: APIPA Medicare/Medicaid	$26.52
Rate for Payer: AZCH Complete Medicare	$11.36
Rate for Payer: Banner UC Health Medicare	$11.36
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: 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	$11.36
Rate for Payer: Self Pay Self Pay	$56.80
Rate for Payer: TriWest Medicare	$11.36
Rate for Payer: UnitedHealth Group of AZ Commercial	$41.39
Rate for Payer: UnitedHealth Group of AZ Medicare	$12.78

Know your out-of-pocket cost for care.

All Charges