Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Alder Tree

Facility

$78.00

Service Code	CPT 86003
Hospital Charge Code	23168775
Hospital Revenue Code	301
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna of AZ Commercial	$70.20
Rate for Payer: Aetna of AZ Medicare	$21.84
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$11.70
Rate for Payer: Amerigroup Medicare	$11.70
Rate for Payer: APIPA Medicare/Medicaid	$29.13
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$11.70
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$11.70
Rate for Payer: Bisbee Police All Plans	$20.28
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$53.04
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cigna of AZ Commercial	$50.70
Rate for Payer: Copperpoint Commercial	$19.30
Rate for Payer: Health Net of AZ Commercial	$46.80
Rate for Payer: Health Net of AZ Medicare	$21.84
Rate for Payer: Humana of AZ Medicare	$11.70
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$62.40
Rate for Payer: TriWest Medicare	$11.70
Rate for Payer: UnitedHealth Group of AZ Commercial	$45.47
Rate for Payer: UnitedHealth Group of AZ Medicare	$14.04

Aldolase LC

Facility

$295.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Aetna of AZ Medicare	$82.60
Rate for Payer: AHCCCS Medicaid	$9.71
Rate for Payer: Allwell Medicaid	$9.71
Rate for Payer: Allwell Medicare	$44.25
Rate for Payer: Amerigroup Medicare	$44.25
Rate for Payer: APIPA Medicare/Medicaid	$110.18
Rate for Payer: AZCH Complete Medicaid	$9.71
Rate for Payer: AZCH Complete Medicare	$44.25
Rate for Payer: Banner UC Health Medicaid	$9.71
Rate for Payer: Banner UC Health Medicare	$44.25
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$200.60
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Cigna of AZ Commercial	$191.75
Rate for Payer: Copperpoint Commercial	$73.01
Rate for Payer: Health Net of AZ Commercial	$177.00
Rate for Payer: Health Net of AZ Medicare	$82.60
Rate for Payer: Humana of AZ Medicare	$44.25
Rate for Payer: Mercy Care Medicaid	$9.71
Rate for Payer: Self Pay Self Pay	$236.00
Rate for Payer: TriWest Medicare	$44.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$171.98
Rate for Payer: UnitedHealth Group of AZ Medicare	$53.10

Aldolase LC

Facility

$295.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna of AZ Commercial	$265.50
Rate for Payer: Bisbee Police All Plans	$76.70
Rate for Payer: Cash Price	$236.00
Rate for Payer: Self Pay Self Pay	$236.00

Aldosterone LCMS, Serum LC

Facility

$508.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$132.08
Max. Negotiated Rate	$457.20
Rate for Payer: Aetna of AZ Commercial	$457.20
Rate for Payer: Bisbee Police All Plans	$132.08
Rate for Payer: Cash Price	$406.40
Rate for Payer: Self Pay Self Pay	$406.40

Aldosterone LCMS, Serum LC

Facility

$508.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$457.20
Rate for Payer: Aetna of AZ Commercial	$457.20
Rate for Payer: Aetna of AZ Medicare	$142.24
Rate for Payer: AHCCCS Medicaid	$40.75
Rate for Payer: Allwell Medicaid	$40.75
Rate for Payer: Allwell Medicare	$76.20
Rate for Payer: Amerigroup Medicare	$76.20
Rate for Payer: APIPA Medicare/Medicaid	$189.74
Rate for Payer: AZCH Complete Medicaid	$40.75
Rate for Payer: AZCH Complete Medicare	$76.20
Rate for Payer: Banner UC Health Medicaid	$40.75
Rate for Payer: Banner UC Health Medicare	$76.20
Rate for Payer: Bisbee Police All Plans	$132.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$345.44
Rate for Payer: Cash Price	$406.40
Rate for Payer: Cash Price	$406.40
Rate for Payer: Cigna of AZ Commercial	$330.20
Rate for Payer: Copperpoint Commercial	$125.73
Rate for Payer: Health Net of AZ Commercial	$304.80
Rate for Payer: Health Net of AZ Medicare	$142.24
Rate for Payer: Humana of AZ Medicare	$76.20
Rate for Payer: Mercy Care Medicaid	$40.75
Rate for Payer: Self Pay Self Pay	$406.40
Rate for Payer: TriWest Medicare	$76.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$296.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$91.44

Aldosterone/Renin Ratio LC

Facility

$508.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$457.20
Rate for Payer: Aetna of AZ Commercial	$457.20
Rate for Payer: Aetna of AZ Medicare	$142.24
Rate for Payer: AHCCCS Medicaid	$40.75
Rate for Payer: Allwell Medicaid	$40.75
Rate for Payer: Allwell Medicare	$76.20
Rate for Payer: Amerigroup Medicare	$76.20
Rate for Payer: APIPA Medicare/Medicaid	$189.74
Rate for Payer: AZCH Complete Medicaid	$40.75
Rate for Payer: AZCH Complete Medicare	$76.20
Rate for Payer: Banner UC Health Medicaid	$40.75
Rate for Payer: Banner UC Health Medicare	$76.20
Rate for Payer: Bisbee Police All Plans	$132.08
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$345.44
Rate for Payer: Cash Price	$406.40
Rate for Payer: Cash Price	$406.40
Rate for Payer: Cigna of AZ Commercial	$330.20
Rate for Payer: Copperpoint Commercial	$125.73
Rate for Payer: Health Net of AZ Commercial	$304.80
Rate for Payer: Health Net of AZ Medicare	$142.24
Rate for Payer: Humana of AZ Medicare	$76.20
Rate for Payer: Mercy Care Medicaid	$40.75
Rate for Payer: Self Pay Self Pay	$406.40
Rate for Payer: TriWest Medicare	$76.20
Rate for Payer: UnitedHealth Group of AZ Commercial	$296.16
Rate for Payer: UnitedHealth Group of AZ Medicare	$91.44

Aldosterone/Renin Ratio LC

Facility

$508.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$132.08
Max. Negotiated Rate	$457.20
Rate for Payer: Aetna of AZ Commercial	$457.20
Rate for Payer: Bisbee Police All Plans	$132.08
Rate for Payer: Cash Price	$406.40
Rate for Payer: Self Pay Self Pay	$406.40

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.11
Rate for Payer: Self Pay Self Pay	$0.11

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.09
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.11
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

Alkaline Phosphatase

Facility

$112.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Aetna of AZ Medicare	$31.36
Rate for Payer: AHCCCS Medicaid	$5.18
Rate for Payer: Allwell Medicaid	$5.18
Rate for Payer: Allwell Medicare	$16.80
Rate for Payer: Amerigroup Medicare	$16.80
Rate for Payer: APIPA Medicare/Medicaid	$41.83
Rate for Payer: AZCH Complete Medicaid	$5.18
Rate for Payer: AZCH Complete Medicare	$16.80
Rate for Payer: Banner UC Health Medicaid	$5.18
Rate for Payer: Banner UC Health Medicare	$16.80
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$76.16
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cigna of AZ Commercial	$72.80
Rate for Payer: Copperpoint Commercial	$27.72
Rate for Payer: Health Net of AZ Commercial	$67.20
Rate for Payer: Health Net of AZ Medicare	$31.36
Rate for Payer: Humana of AZ Medicare	$16.80
Rate for Payer: Mercy Care Medicaid	$5.18
Rate for Payer: Self Pay Self Pay	$89.60
Rate for Payer: TriWest Medicare	$16.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$65.30
Rate for Payer: UnitedHealth Group of AZ Medicare	$20.16

Alkaline Phosphatase

Facility

$112.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$29.12
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of AZ Commercial	$100.80
Rate for Payer: Bisbee Police All Plans	$29.12
Rate for Payer: Cash Price	$89.60
Rate for Payer: Self Pay Self Pay	$89.60

Alk Phos Isoenzyme LC

Facility

$159.00

Service Code	CPT 84080
Hospital Charge Code	1905896
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
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	$14.78
Rate for Payer: Allwell Medicaid	$14.78
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	$14.78
Rate for Payer: AZCH Complete Medicare	$23.85
Rate for Payer: Banner UC Health Medicaid	$14.78
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	$14.78
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

Alk Phos Isoenzyme LC

Facility

$159.00

Service Code	CPT 84080
Hospital Charge Code	1905896
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

ALLERGEN CHOC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN CHOC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN CORN

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN CORN

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN EGG

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN EGG

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN FISH/SHELL MIX

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN FISH/SHELL MIX

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN PORK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$9.75
Rate for Payer: Amerigroup Medicare	$9.75
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$9.75
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$9.75
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$9.75
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$9.75
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN PORK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

Know your out-of-pocket cost for care.

All Charges