Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Allergen Profile, Basic Food LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	1902246
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 Profile, Basic Food LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	1902246
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

Allergens w/Total IgE 11 LC

Facility

$1,180.00

Service Code	CPT 86003
Hospital Charge Code	23773230
Hospital Revenue Code	302
Min. Negotiated Rate	$306.80
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Bisbee Police All Plans	$306.80
Rate for Payer: Cash Price	$944.00
Rate for Payer: Self Pay Self Pay	$944.00

Allergens w/Total IgE 11 LC

Facility

$1,180.00

Service Code	CPT 86003
Hospital Charge Code	23773230
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Aetna of AZ Medicare	$330.40
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$177.00
Rate for Payer: Amerigroup Medicare	$177.00
Rate for Payer: APIPA Medicare/Medicaid	$440.73
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$177.00
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$177.00
Rate for Payer: Bisbee Police All Plans	$306.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$802.40
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cigna of AZ Commercial	$767.00
Rate for Payer: Copperpoint Commercial	$292.05
Rate for Payer: Health Net of AZ Commercial	$708.00
Rate for Payer: Health Net of AZ Medicare	$330.40
Rate for Payer: Humana of AZ Medicare	$177.00
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$944.00
Rate for Payer: TriWest Medicare	$177.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$687.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$212.40

Allergens w/Total IgE Area 12 LC

Facility

$1,180.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Aetna of AZ Medicare	$330.40
Rate for Payer: AHCCCS Medicaid	$16.46
Rate for Payer: Allwell Medicaid	$16.46
Rate for Payer: Allwell Medicare	$177.00
Rate for Payer: Amerigroup Medicare	$177.00
Rate for Payer: APIPA Medicare/Medicaid	$440.73
Rate for Payer: AZCH Complete Medicaid	$16.46
Rate for Payer: AZCH Complete Medicare	$177.00
Rate for Payer: Banner UC Health Medicaid	$16.46
Rate for Payer: Banner UC Health Medicare	$177.00
Rate for Payer: Bisbee Police All Plans	$306.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$802.40
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cigna of AZ Commercial	$767.00
Rate for Payer: Copperpoint Commercial	$292.05
Rate for Payer: Health Net of AZ Commercial	$708.00
Rate for Payer: Health Net of AZ Medicare	$330.40
Rate for Payer: Humana of AZ Medicare	$177.00
Rate for Payer: Mercy Care Medicaid	$16.46
Rate for Payer: Self Pay Self Pay	$944.00
Rate for Payer: TriWest Medicare	$177.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$687.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$212.40

Allergens w/Total IgE Area 12 LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	23756989
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

Allergens w/Total IgE Area 12 LC

Facility

$1,180.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$306.80
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna of AZ Commercial	$1,062.00
Rate for Payer: Bisbee Police All Plans	$306.80
Rate for Payer: Cash Price	$944.00
Rate for Payer: Self Pay Self Pay	$944.00

Allergens w/Total IgE Area 12 LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	23756989
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

Allergens, Zone 16 LC

Facility

$1,842.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$478.92
Max. Negotiated Rate	$1,657.80
Rate for Payer: Aetna of AZ Commercial	$1,657.80
Rate for Payer: Bisbee Police All Plans	$478.92
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Self Pay Self Pay	$1,473.60

Allergens, Zone 16 LC

Facility

$1,842.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$1,657.80
Rate for Payer: Aetna of AZ Commercial	$1,657.80
Rate for Payer: Aetna of AZ Medicare	$515.76
Rate for Payer: AHCCCS Medicaid	$5.22
Rate for Payer: Allwell Medicaid	$5.22
Rate for Payer: Allwell Medicare	$276.30
Rate for Payer: Amerigroup Medicare	$276.30
Rate for Payer: APIPA Medicare/Medicaid	$687.99
Rate for Payer: AZCH Complete Medicaid	$5.22
Rate for Payer: AZCH Complete Medicare	$276.30
Rate for Payer: Banner UC Health Medicaid	$5.22
Rate for Payer: Banner UC Health Medicare	$276.30
Rate for Payer: Bisbee Police All Plans	$478.92
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,252.56
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Cigna of AZ Commercial	$1,197.30
Rate for Payer: Copperpoint Commercial	$455.90
Rate for Payer: Health Net of AZ Commercial	$1,105.20
Rate for Payer: Health Net of AZ Medicare	$515.76
Rate for Payer: Humana of AZ Medicare	$276.30
Rate for Payer: Mercy Care Medicaid	$5.22
Rate for Payer: Self Pay Self Pay	$1,473.60
Rate for Payer: TriWest Medicare	$276.30
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,073.89
Rate for Payer: UnitedHealth Group of AZ Medicare	$331.56

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: AHCCCS Medicaid	$6,558.79
Rate for Payer: Allwell Medicaid	$6,558.79
Rate for Payer: AZCH Complete Medicaid	$6,558.79
Rate for Payer: Banner UC Health Medicaid	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: AHCCCS Medicaid	$2,311.11
Rate for Payer: Allwell Medicaid	$2,311.11
Rate for Payer: AZCH Complete Medicaid	$2,311.11
Rate for Payer: Banner UC Health Medicaid	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: AHCCCS Medicaid	$3,439.67
Rate for Payer: Allwell Medicaid	$3,439.67
Rate for Payer: AZCH Complete Medicaid	$3,439.67
Rate for Payer: Banner UC Health Medicaid	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: AHCCCS Medicaid	$13,151.25
Rate for Payer: Allwell Medicaid	$13,151.25
Rate for Payer: AZCH Complete Medicaid	$13,151.25
Rate for Payer: Banner UC Health Medicaid	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: AHCCCS Medicaid	$2,311.11
Rate for Payer: Allwell Medicaid	$2,311.11
Rate for Payer: AZCH Complete Medicaid	$2,311.11
Rate for Payer: Banner UC Health Medicaid	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: AHCCCS Medicaid	$2,311.11
Rate for Payer: Allwell Medicaid	$2,311.11
Rate for Payer: AZCH Complete Medicaid	$2,311.11
Rate for Payer: Banner UC Health Medicaid	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: AHCCCS Medicaid	$3,439.67
Rate for Payer: Allwell Medicaid	$3,439.67
Rate for Payer: AZCH Complete Medicaid	$3,439.67
Rate for Payer: Banner UC Health Medicaid	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: AHCCCS Medicaid	$3,439.67
Rate for Payer: Allwell Medicaid	$3,439.67
Rate for Payer: AZCH Complete Medicaid	$3,439.67
Rate for Payer: Banner UC Health Medicaid	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: AHCCCS Medicaid	$13,151.25
Rate for Payer: Allwell Medicaid	$13,151.25
Rate for Payer: AZCH Complete Medicaid	$13,151.25
Rate for Payer: Banner UC Health Medicaid	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8112
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: AHCCCS Medicaid	$6,558.79
Rate for Payer: Allwell Medicaid	$6,558.79
Rate for Payer: AZCH Complete Medicaid	$6,558.79
Rate for Payer: Banner UC Health Medicaid	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79

Allergic Reactions

Facility

$2,311.11

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$2,311.11
Max. Negotiated Rate	$2,311.11
Rate for Payer: AHCCCS Medicaid	$2,311.11
Rate for Payer: Allwell Medicaid	$2,311.11
Rate for Payer: AZCH Complete Medicaid	$2,311.11
Rate for Payer: Banner UC Health Medicaid	$2,311.11
Rate for Payer: Mercy Care Medicaid	$2,311.11

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: AHCCCS Medicaid	$6,558.79
Rate for Payer: Allwell Medicaid	$6,558.79
Rate for Payer: AZCH Complete Medicaid	$6,558.79
Rate for Payer: Banner UC Health Medicaid	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79

Allergic Reactions

Facility

$3,439.67

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG8114
Min. Negotiated Rate	$3,439.67
Max. Negotiated Rate	$3,439.67
Rate for Payer: AHCCCS Medicaid	$3,439.67
Rate for Payer: Allwell Medicaid	$3,439.67
Rate for Payer: AZCH Complete Medicaid	$3,439.67
Rate for Payer: Banner UC Health Medicaid	$3,439.67
Rate for Payer: Mercy Care Medicaid	$3,439.67

Allergic Reactions

Facility

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8113
Min. Negotiated Rate	$13,151.25
Max. Negotiated Rate	$13,151.25
Rate for Payer: AHCCCS Medicaid	$13,151.25
Rate for Payer: Allwell Medicaid	$13,151.25
Rate for Payer: AZCH Complete Medicaid	$13,151.25
Rate for Payer: Banner UC Health Medicaid	$13,151.25
Rate for Payer: Mercy Care Medicaid	$13,151.25

Allergic Reactions

Facility

$6,558.79

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG8111
Min. Negotiated Rate	$6,558.79
Max. Negotiated Rate	$6,558.79
Rate for Payer: AHCCCS Medicaid	$6,558.79
Rate for Payer: Allwell Medicaid	$6,558.79
Rate for Payer: AZCH Complete Medicaid	$6,558.79
Rate for Payer: Banner UC Health Medicaid	$6,558.79
Rate for Payer: Mercy Care Medicaid	$6,558.79

Know your out-of-pocket cost for care.

All Charges