Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Allergen Profile, Basic Food LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	1902246
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

Allergens(14) LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	28068399
Hospital Revenue Code	305
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

Allergens(14) LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	28068399
Hospital Revenue Code	305
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EAC

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143914
Hospital Revenue Code	301
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Aetna of AZ Medicare	$11.48
Rate for Payer: Allwell Medicare	$6.56
Rate for Payer: Amerigroup Medicare	$6.56
Rate for Payer: APIPA Medicare/Medicaid	$15.31
Rate for Payer: AZCH Complete Medicare	$6.56
Rate for Payer: Banner UC Health Medicare	$6.56
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$27.88
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cigna of AZ Commercial	$26.65
Rate for Payer: Copperpoint Commercial	$10.15
Rate for Payer: Health Net of AZ Commercial	$24.60
Rate for Payer: Health Net of AZ Medicare	$11.48
Rate for Payer: Humana of AZ Medicare	$6.56
Rate for Payer: Self Pay Self Pay	$32.80
Rate for Payer: TriWest Medicare	$6.56
Rate for Payer: UnitedHealth Group of AZ Commercial	$23.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$7.38

ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, EAC

Facility

$41.00

Service Code	CPT 86003
Hospital Charge Code	23143914
Hospital Revenue Code	301
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$36.90
Rate for Payer: Aetna of AZ Commercial	$36.90
Rate for Payer: Bisbee Police All Plans	$10.66
Rate for Payer: Cash Price	$32.80
Rate for Payer: Self Pay Self Pay	$32.80

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	$188.80
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: Allwell Medicare	$188.80
Rate for Payer: Amerigroup Medicare	$188.80
Rate for Payer: APIPA Medicare/Medicaid	$440.73
Rate for Payer: AZCH Complete Medicare	$188.80
Rate for Payer: Banner UC Health Medicare	$188.80
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: 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	$188.80
Rate for Payer: Self Pay Self Pay	$944.00
Rate for Payer: TriWest Medicare	$188.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$687.94
Rate for Payer: UnitedHealth Group of AZ Medicare	$212.40

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 Area 12 LC

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	23756989
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
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: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
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: 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	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

Allergens w/Total IgE Area 12 LC

Facility

$131.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$34.06
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Cash Price	$104.80
Rate for Payer: Self Pay Self Pay	$104.80

Allergens w/Total IgE Area 12 LC

Facility

$131.00

Service Code	CPT 82785
Hospital Charge Code	22311173
Hospital Revenue Code	302
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$117.90
Rate for Payer: Aetna of AZ Commercial	$117.90
Rate for Payer: Aetna of AZ Medicare	$36.68
Rate for Payer: Allwell Medicare	$20.96
Rate for Payer: Amerigroup Medicare	$20.96
Rate for Payer: APIPA Medicare/Medicaid	$48.93
Rate for Payer: AZCH Complete Medicare	$20.96
Rate for Payer: Banner UC Health Medicare	$20.96
Rate for Payer: Bisbee Police All Plans	$34.06
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$89.08
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cigna of AZ Commercial	$85.15
Rate for Payer: Copperpoint Commercial	$32.42
Rate for Payer: Health Net of AZ Commercial	$78.60
Rate for Payer: Health Net of AZ Medicare	$36.68
Rate for Payer: Humana of AZ Medicare	$20.96
Rate for Payer: Self Pay Self Pay	$104.80
Rate for Payer: TriWest Medicare	$20.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$76.37
Rate for Payer: UnitedHealth Group of AZ Medicare	$23.58

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, Zone 16 LC

Facility

$1,750.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna of AZ Commercial	$1,575.00
Rate for Payer: Aetna of AZ Medicare	$490.00
Rate for Payer: Allwell Medicare	$280.00
Rate for Payer: Amerigroup Medicare	$280.00
Rate for Payer: APIPA Medicare/Medicaid	$653.62
Rate for Payer: AZCH Complete Medicare	$280.00
Rate for Payer: Banner UC Health Medicare	$280.00
Rate for Payer: Bisbee Police All Plans	$455.00
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,190.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Cigna of AZ Commercial	$1,137.50
Rate for Payer: Copperpoint Commercial	$433.12
Rate for Payer: Health Net of AZ Commercial	$1,050.00
Rate for Payer: Health Net of AZ Medicare	$490.00
Rate for Payer: Humana of AZ Medicare	$280.00
Rate for Payer: Self Pay Self Pay	$1,400.00
Rate for Payer: TriWest Medicare	$280.00
Rate for Payer: UnitedHealth Group of AZ Commercial	$1,020.25
Rate for Payer: UnitedHealth Group of AZ Medicare	$315.00

Allergens, Zone 16 LC

Facility

$1,750.00

Service Code	CPT 86003
Hospital Charge Code	22311174
Hospital Revenue Code	302
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna of AZ Commercial	$1,575.00
Rate for Payer: Bisbee Police All Plans	$455.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Self Pay Self Pay	$1,400.00

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

$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

$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	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	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

$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

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

$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

$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

$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

$13,151.25

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG8112
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

Know your out-of-pocket cost for care.

All Charges